LIBRARY OF CONGRESS. 

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UNITED STATES OF AMERICA. 




Fig. 1.— Consulting Lectures. 



DOMESTIC 

MEDICAL LECTURES 

EMBRACING 

A THOROUGH TREATISE ON THE CAUSE, PREVEN- 
TION, TREATMENT AND CURE OF THE 
MOST PREVALENT DISEASES. 



JOHN KEAN, M. D. 



3Smi*IIt£f)£& fcotii) uumtrous full-pap^ Illustrations. 






CHICAGO, ILL.: 
173 SOUTH CLARK STREET 

1879. 



rr 






Entered according to act of Congress, in the year 1879, by 

JOHN KEAN, M. D. 

in the office of the Librarian of Congress. 

All rights reserved. 



Hreface. 



IN placing this volume before the earnest reader, 
my aim is to impart a brief yet correct descrip- 
tion of the principal diseases; their course, 
nature, symptoms by which they are known, and 
treatment, preventive and curative, in simple lan- 
guage as free from technical terms as possible, in 
order that a safe guide may be given for those 
relying on their own resources. 

At this time there seems to be no reliable hand- 
book of medicine for ordinary use, the larger por- 
tion being written for professional men, and 
abounding is such phrases as are familiar only to 
medical scholars, but to the casual reader are 
discouraging and difficult to be understood. 

In this work many obscure and exceptional 
diseases, and uncommon manifestations of ordi- 
nary diseases, are, as a rule, purposely omitted, 
though some which are difficult to determine 
and treat are described, in order to assist persons 
called upon to do the best they can for some 
friend or relative. 



vi Preface. 

Where there is a diversity of opinion as to the 
best among various modes of treatment, to avoid 
confusion, as a rule, only one is given, that which 
the author has found to be the best in many 
years' practice and experience. 

In severe and complicated cases, a medical prac- 
titioner of recognized ability should be called, as 
no degree of care or detailed description will 
enable the non-medical reader to take the life of 
a patient in his hands with impunity, where the 
severity and even danger of the disease would 
demand the most efficient treatment of a medical 
practitioner of acknowledged skill, acquired by 
extended experience. 

But in mild cases of many common diseases, it 
is possible for any person of reasonable intelli- 
gence to treat them satisfactorily by aid of writ- 
ten instructions ; and, moreover, where the patient 
and his nurses have an understanding of what is 
desired by the attending physician, they may 
render important assistance and obviate mistakes. 

When impracticable to procure medical attend- 
ance, persons thus situated should exercise the 
greatest care in the study of these lectures, and 
so become competent to deal with many ailments 
without the aid of a physician, if only through 
the first or milder stages of threatening attacks. 

It may be well here to caution the reader 
against adopting active treatment in any case 
where he does not see before him a definite object 



Preface. vii 

to be accomplished. It requires a good deal of 
courage on the part of the patient and his attend- 
ants to abstain from doing anything till they see 
a reason why, but this is much safer than hap- 
hazard treatment, with large doses of potent rem- 
edies. When no very clear indications for treat- 
ment are perceived, small doses of drugs such as 
diaphoretic powder or solution of acetate of am- 
monia, which induce perspiration, are often of 
great value and are not likely to do harm. And 
if the case be chronic, moderate doses of tonics 
may be tried until a change is presented. 

Remember that the whole of the symptoms 
described under any disease are not to be expected 
in every case, nor should surprise be excited by 
the appearance of undescribed symptoms. 

Nature does not always conform to a given sys- 
tem of fixed principles, and hence no single case 
resembles another, except, perhaps, in some prom- 
inent features in a typical class of cases. 

Therefore it will not be insisted that the author 
can here give more than a clear general descrip- 
tion of the symptoms of each disease. With the 
fullest description of diseases that the author has 
been able to give in the space here assigned, an 
important difficulty, still to be overcome, is the 
procurement of pure and fresh drugs (see page 
524, on poisons) ; but to persons who have sub- 
scribed for this book, and those who reside at 
any point however remote from the city, or whose 



viii Preface. 

business requires them to change from place to 
place, drugs can be forwarded either by express 
or in a common envelope by mail, in a fully pro- 
tected condition from any kind of injury or loss. 

Persons writing for medicines should give a 
full description of the case, and if in the author's 
judgment there are other remedies better adapted 
to the case than those ordered, such remedies will 
be substituted without extra charge. 

If in any passage through the course of this 
treatise the author has erred, he parts with the 
book confident that such error is of but minor 
importance, and that his chief aim — namely to 
assist each and every person who may need it to 
inexpensive self-treatment — will be successfully 
attained. 



C N T E N T 8. 



Preface Page 5 

List of Illustrations " 14 

Alphabetical Index " 531 



LECTURE I. 

Food.— Meals— Drink.— Tea.— Coffee.— Cocoa.— Milk.— 
Water; Test.— Filters. — Various Drinks. — Alcohol. — 
Exercise. — Bathing. — Teeth.— Clothing.— Sleep.— Med- 
icines. — Purgatives. — Soothing Medicines. — Dwell- 
ings Page IT 



LECTURE II. 

General Diseases — Small Pox.— Chicken Pox.— Measles. 
—Rubeola. — Scarlet Fever.— Cerebro-Spinal Fever.— 
Typhus Fever.— Typhoid Fever. — Dengue. — Erysip- 
elas.— Mumps.— Whooping Cough.— Yellow Fever.— 
Plague.— Diphtheria.— Relapsing Fever.— Cholera.— 
Influenza. — Pyaemia. — Puerperal Fever Page 32 



LECTURE III. 

Simple Continued Fever or Ague.— Remittent Fever.— 
Intermittent Fever.— Hydrophobia Page 113 



x Contents. 

LEOTUEE IV. 

Acute Rheumatism. — Rheumatism. — Gout. — Rheumatic 
Arthritis.— Cancer.— Lupus and Rodent Ulcer.— Lep- 
rosy. — Scrofula. — Rickets. — Cretinism. — Diabetes. — 
Puerpera. — Scurvy. — Anaemia. — Chlorosis. — General 
Dropsy.— Beri-Beri Page 123 



LECTURE V. 

Inflammation of the Brain and Membranes, or Encephali- 
tis. — Inflammation of the Membranes, or Meningitis. — 
Acute Hydrocephalus. — Inflammation, Softening and 
Abscess of the Brain. — Sunstroke. — Chronic Hydroceph- 
alus, or Water on the Brain. — Hypertrophy, Atrophy, 
and Tumors of the Brain.— Apoplexy. Diseases op the 
Spinal Cord —Inflammation of the Membranes of the 
Cord. — Inflammation of the Spinal Cord. — Spinal Hem- 
orrhage.— Spina Bifida (in infants). Diseases op the 
Nerves— Paralysis, or Palsy.— Paraplegia.— Paralytic 
Stroke, or Hemiplegia. — Locomotor Ataxy. — Wasting 
Palsy. — Infantile Paralysis. — Facial Paralysis.— Shak- 
ing Palsy. — Writers 1 Cramp.— Glosso-laryngeal Paral- 
ysis. — Cramp, or Spasms. — Child-Crowing. — Chorea. 
Functional Diseases of Nervous System — Tetanus, 
or Lock-jaw. — Epilepsy. — Hysteria. — Neuralgia. — Tic- 
douloureux. — Megrims.— Sciatica.— Intercostal Neu- 
ralgia.— Irritable Breast. Disorders of Intellect— 
Mania. — Melancholia. — Dementia.— General Paralysis 
of the Insane Page 160 



LECTURE VI. 

Affections of the Eye — Catarrhal Ophthalmia. — Pustu- 
lar or Strumous Ophthalmia.— Purulent Ophthalmia.— 
Inflammation of the Cornea. — Ulcers of the Cornea.— 
Foreign Bodies in the Eye.— Iritis.— Cataract.— Short 
Sight. — Long Sight. — Weak Sight. — Astigmatism.— 
Strabismus. — Squinting. — Night Blindness. — Color 
Blindness. Affections of the Eyelids — Inflamma- 
tion of Edge of Lids. — Stye. — Inverted Eyelashes.— 
Bruises ' Page 252 



Contents. xi 

LECTUKE VII. 

Affections of the Ear— Earache.— Inflammation of the 
External Ear. — Inflammation of the Inner Ear. — Run- 
ning from the Ear.— Bleeding from the Ear Page 282 

LECTURE VIII. 

Diseases of the Circulatory System— Inflammation of 
the Pericardium. — Diseases of the Valves and Hyper- 
trophy. — Breast-pang, or Angina Pectoris. — Palpita- 
tion.— Atheroma. — Aneurism. — Inflammation of Veins. 
— White or Milk Leg.— Varicose Veins. — Goitre. — Ex- 
ophthalmic Goitre. — Enlarged Spleen, or Ague- 
cake '. . . . Page 287 

LECTUEE IX. 

Diseases of the Air Passages — Catarrh. — Ozena.— 
Bleeding from the Nose.— Sore Throat. — Ulcers and 
Dropsy of the Windpipe ((Edema Glottidis). — Croup. 
—Hay Asthma. — Bronchitis (acute and chronic). — Bron- 
chiectasis. — Asthma. — Emphysema. — Bleeding from 
the Lungs, or Hemoptysis. — Pneumonia. — Consump- 
tion. — Pleurisy (acute and chronic) — Page 304 

LECTURE X. 

Diseases of the Digestive Organs — Inflammation ol 
Mouth.— Toothache. — Inflammation and Ulcers of the 
Tongue. — Cracked Tongue and Ranula. — Quinsy. — 
Chronic Inflammation oi Tonsils. — Inflammation of 
the Throat. Affections of the Stomach— Indigestion 
or Dyspepsia.— Inflammation of the Stomach.— Chronic 
Ulcer of the Stomach. — Vomiting of Blood from the 
Stomach. — Cancer of the Stomach. Affections of 
the Bowels — Inflammation of the Bowels. — Dysen- 
tery.— Bleeding from the Bowels. — Diarrhoea. — Colic. 
— Constipation. — Worms.— Piles. Affections of the 
Liver — Abscess. — Atrophy, and Cirrhosis. — Waxy 
Liver. — Fatty Liver. — Cancer and Tubercle. — Conges- 
tion of the Liver. — Jaundice. — Gall Stones. Affec- 
tions of the Peritoneum — Peritonitis. — Ascites, or 
Dropsy of the Abdomen. — Tabes Mesenterica, or con- 
sumption of the Bowels. Page 361 



xii Contents. 

LECTUKE XL 

Diseases of the Urinary System — (N. B. Venereal dis- 
eases are given in Lectures published separately.)— Uri- 
nary Sediments, or Gravel.— Uric or Lithic, Phospha- 
tic and Oxalic Diatheses. — Stone in the Kidney. — 
Bright's Disease. — Inflammation of the Kidney. — Hem- 
aturia, or Blood in the Urine. — Suppression, Retention 
and Incontinence of Urine. — Inflammation of the Blad- 
der.— Stone in the Bladder.— The Urine Page 433 



LECTURE XII. 

Diseases of the Skin — (N. B. See Lectures on Venereal 
Diseases, published separately.)— Erythema. — Uticaria 
or Nettle Rash. — Lichen.— Red or White Gum. — Prur- 
igol — Psoriasis or Lepra. — Ichthyosis.— Herpes or Tet- 
ter.— Shingles.— Pemphigus.— Rupia.— Eczema.— Acne. 
—Corns.— Bunions.— Warts.— Freckles.— Boils.— Chil- 
blains. — Ringworm. — Fawns. — Bald Spots. — Liver 
Spots.— Itch Page 449 



LECTURE XIII. 

Diseases and Management of Children— Diet.— Clean- 
liness.— Sleep.— Clothing.— Teething.— Chafing.— Flat- 
ulence. — Griping. — Convulsions. — Diarrhoea. — Red 
Gum.— Thrush.— Vomiting Page 469 



LECTURE XIV. 

Old Age and Degeneration Page 483 



LECTURE XY. 

Local Injuries and Emergencies— Hemorrhage.— Bruis- 
es.— Burns and Scalds.— Choking.— Incised Wounds. 
— Dislocations and Fractures. — Sprains.— Drown- 
ing Page 487 



Contents. xiii 

LECTUEE XVI. 

Alkaline Springs — Author prospected to find, near 
Chicago. — Difficult to Discover. — Finally one of great 
medical value is reached. — Result of Analysis. — Pa- 
tients repair thither.— Baths free of charge.— Easy ac- 
cess by railroad.— Beautiful Scenery. — Fine Atmo- 
sphere.— Most Healthy Summer Resort,— Commanding 
View over miles of Country Page 499 



LECTURE XVII. 

Poisons— Their Effects and Treatment.— Alcohol.— Digit- 
alis. — Ergot. — Strychnine. — Arsenic. — Antimony.— 
Brassfounders 1 A^ue. — Chromates.— Copper Colic.— 
Iodine.— Lead Colic and Palsy.— Mercury.— Phosphor- 
us.— Nitrate of Silver.— Gases.— Mineral Acids.— Alka- 
lies. — Metals. — Narcotics. — Deliriants. — Inebriants. — 
Convulsives.— Depressants.— Cantharides. — Stings and 
Bites. — Adulterations. — Precautionary Rules. . Page 502 



LECTURE XVIII. 

Mock Colleges and Quacks. — Science : What it has Done. 
— Its results in Continental Europe, England, and the 
United States Compared.— Imperfections of Human 
Affairs. — Wrecks of Trusted Leaders. — Growing Evils of 
Sham Colleges. — Inroads by Impostors upon the Medi- 
cal Profession. — Auctioned Diplomas. — Legislation 
Needed to Check. — Boards, Commissions, Committees 
Liable to be Swayed from Duty.— State Medical Faculty, 
and How it might be formed.— How Medical Profession 
is being Protected Against Invasion Page 5*26 



.LIST OF ILLUSTRATIONS. 



FIG. 
1. 



9. 

10. 

11. 

12. 
13. 
14. 
15. 
16. 
17. 
18. 
19. 
20. 
•21. 
22. 
23. 
24. 
25. 
26. 
27. 
28. 
29. 



Consulting Lectures, 
Author Citing Lectures, 

Sick Room, 

Cerebro-Spinal Fever, 
Typhus Fever, .... 
Cynanche Parotides a (Mumps), 
Yellow Fever, .... 
Hydrophobia, .... 

Gout, 

Scirrhcjs Cancer, . 

Hard Cancer, .... 

Secondary Cancer, 

Medullar? Cancer, 

Epithelial Cancer, 

Lupus Cancer, .... 

Chronic Lupus Cancer, 

Scrofulous Mother and Child, 

Rickets, 

Chlorosis, 

Meningitis, 

Abscess of the Brain, 
Coup de Soleil (Sunstroke), 

Apoplexy, 

Effusion on the Brain, 
Premonitory Warnings, 
Epilepsy without Convulsions, 
Aura Epileptica, .... 

Hysteria, 

Hysteria Prostrate, . 



page. 
2 

16 

44 
70 
74 
88 
94 

120 
. 132 

1:58 
. 1538 

139 
. 140 

141 
. 141 

142 
. 144 

147 
. 158 

172 
. 181 

182 
. 187 

189 
. 190 

216 
. 218 

230 
. 236 



Illustrations. xv 

Page. 

Melancholia, 246 

Eye, 252 

Catarrhal Ophthalmia, .... 258 

Purulent Ophthalmia 263 

Ear, 282 

Tinnitus Aurilm, 284 

Foreign Bodies in the Ear, . . . 286 

Consultation, 302 

Croup, 316 

Internal Organs, 320 

Asthma, 336 

Pneumonia, 342 

Tonsillitis (Quinsy;, 366 

Ulcer of the Stomach, 390 

Cancer of the Stomach, .... 395 

Hemorrhoids (Piles), . . . . . 416 

Peritonitis, 423 

Lichen, 452 

Food, 468 

Nourishment, 471 

Sleep, 474 

Old Age, 483 

Degeneration, 484 

Preventing Hemorrhage, . .486 

Sprain, 492 

Alkaline Spring, 498 

Effects of Deliriants, 520 




Fig. 2.— Author Citing Lectures. 



GENERAL OBSERVATIONS. 



LECTURE I. 

Food.— Meals.— Drink.— Tea.— Coffee.— Cocoa.— Milk.— 
Water; Test.— Filters.— Various Drinks.— Alcohol.— 

Exercise.— Bathing.— Teeth.— Clothing.— Sleep.— Med- 
icines. — Purgatives. — Soothing Medicines. — Dwell- 
ings. 

CyOME of the theories in this work are not 
|^ accepted by all physicians, owing to their 
■* bias in favor of some particular school, and 
they are not upheld as being ultimately infallible ; 
but in all cases they are useful as giving an intel- 
ligent understanding of the subject and enabling 
us to apply our knowledge of the facts to the best 
advantage. 

The facts are strictly accurate, and are final: 
thus a faithful account of the signs and symp- 
toms of all diseases centuries ago would be 
exactly the same as such an account in the 
present day, in all cases being descriptions of 
unchanging facts ; but our interpretation of these 
facts and consequent treatment would be widely 
different. 

The treatments I recommend are the best 
known up to the present time. Most of them 
have been personally tried by me in a tolerably 



18 Dr. J. Keari's Lectures. 

extensive practical experience, and, when not 
so tried, they have been taken from standard 
authorities. 

As prevention is proverbially better than cure, 
the following short advice for the preservation of 
health will appropriately precede the account of 
diseases. 

FOOD. 

The meals should be at regular intervals, as a 
general rule three times a day, and no food taken 
between them, to allow the stomach intervals of 
rest. 

At the usual time for meals the stomach be- 
comes active, and if this time be passed, food is 
not so readily digested and should be taken in 
1 ess quantity ; to avoid thus causing it double work 
we should not vary the time of our daily meals. 

The food should be well cooked and changed 
from time to time to avoid monotony, causing 
disgust and bad digestion. The food should be 
well masticated and eaten slowly, and half-an- 
hour allowed to elapse after a meal before com- 
mencing business. More food is required when 
occupied than at rest. 

MEALS. 

The first meal should be taken before entering 
upon the business of the day, and for those hav- 
ing good digestion, most mental or physical 
labor can be accomplished on fatty food. 



Drinks. 19 

Dinner should be taken early in the day, and 
ought to be the principal meal ; the kind of food 
does not matter much so long as it is well cooked 
and sufficient in quantity, but those having weak 
digestions should avoid cheese, pickles, spices 
and pastry. 

Supper should not be a heavy meal, and should 
be taken some time before going to bed. 

Hard work can be done in perfect health with- 
out animal food. Rice, oatmeal, flour and maize, 
along with milk, are all good and cheap staple 
foods, and quite sufficient for both health and 
labor; but animal food is more digestible and 
contains more nourishment in an equal weight. 

Potatoes and vegetables are valuable parts of 
dietary, especially where milk cannot be had. 

DRINK. 

A man requires from two to three pints of fluid 
daily, between his food and drink. Drink should 
betaken chiefly with meals; a moderate amount 
favors digestion. 

TEA, COFFEE, COCOA. 
Tea, coffee and cocoa in moderation are whole- 
some and excellent drinks, acting as gentle 
stimulants and favoring digestion, but if taken 
too often, too strong, or in immoderate quantity, 
they are apt to cause indigestion and nervous 
headache. Coffee and green tea are the most 
stimulating, often causing light symptoms of 



20 Dr. J. Kean's Lectures. 

poisoning. Cocoa is the least stimulating but 
most nutritious. They all diminish the waste 
of the body and remove the sense of fatigue. 

MILK. 

Milk is both food and drink, and may be used 
with advantage either natural, sweetened or 
boiled. A considerable amount of the indiges- 
tion and decayed teeth of the present day is due 
to the use of hot sweet drinks, which might be 
avoided by substituting milk for tea or coffee. 
One of the best ways of taking fluid with dinner 
is in the form of soup and broth. 

WATER. 

Water should be clear, transparent, and free 
from suspended particles, and should be entirely 
without smell ; some colored waters, however, are 
fairly wholesome when the coloring matter is 
iron, clay or peat ; while some clear waters are 
unwholesome from containing organic matter. 
Water from deep wells is to be preferred to sur- 
face water or water from shallow wells, as it 
is less liable to be contaminated by soaking of 
drainage or cesspools. 

TEST. 

To form a proper opinion a chemical and mi- 
croscopical examination of the water is neces- 
sary, but a rough test may be applied as follows : 



Test. 21 

half till a clean stoppered bottle, replace the stop- 
per and put it to stand in a warm place for five 
days, when there will be a disagreeable putrid 
odor if it contains organic matter. If the water 
is bad either from containing organic matter or 
from being too hard, all used for drinking, cook- 
ing, and washing dishes should first be boiled and 
then filtered. Boiling throws down most of the 
salts causing temporary hardness and forming 
the crust in kettles, leaving the water much softer, 
and after standing a day, or being poured from 
vessel to vessel several times to get back the air 
expelled by boiling, it is also more palatable. 
Boiling also destroys some of the organic matter, 
and in most cases renders the remainder innocu- 
ous by destroying the disease germs. Filtering 
removes the grosser impurities, destroys some of 
the organic matter, and if the material used be 
spongy iron or vegetable charcoal, it will for a 
time remove some of the salts in solution. The 
filtering material should be renewed every three 
to twelve months according to the quality and 
quantity of water passed through it, and filters 
which profess to last forever or to be self-cleans- 
ing should be avoided. Spongy iron filters are 
the best, but are very expensive, and animal char- 
coal is very good for a more limited time ; after 
long use the charcoal must be reburnt or fresh 
charcoal procured. 



22 Dr. J. K sail's Lectures. 

HOW TO CONSTRUCT A FILTER. 

Procure a twelve-inch flower-pot ; cover the hole 
with a piece of perforated zinc, and fill with clean 
gravel, the larger pieces being below, to a depth of 
three inches ; above the gravel place three inches 
thick of white sand well washed ; above the sand 
place four inches thick of animal charcoal which 
has been cleansed in boiling water four times. 

Pour the water to be filtered into the flower-pot 
and let it run through the hole into a glass bottle 
beneath. When the charcoal becomes clogged 
from continued use, scrape off the top, boil it two 
or three times, dry it and use as- before. If drink- 
ing water is kept in the house, it should be in 
glazed earthenware or stone jars with covers, 
which should occasionally be emptied and wiped 
with a clean cloth. 

Cisterns should be emptied and thoroughly 
cleaned out from time to time, and be provided 
with a cover to exclude dust. 

The want of palatable water and soup at din- 
ner is and has been the cause of the widespread 
use of beer as a beverage, when otherwise it 
would be neither desired nor needed. 

VARIOUS DRINKS. 

For quenching thirst the various acid drinks, 
such as cetric acid and vinegar, are very pleas- 
ant, but should not be indulged in by those of 
rheumatic tendencies. Cold tea is a most refresh- 



Alcohol 23 

ing drink, especially in prolonged travelling. The 
best drink for severe physical exertion is oatmeal 
and water; \ ft oatmeal boiled in three quarts 
of water and sweetened with X% ounces of sugar, 
used hot in winter and cold in summer, is a sus- 
taining and thirst-quenching drink superior to 
any other. To be shaken before, taken. 

ALCOHOL. 

For the great majority of persons under middle 
age alcohol in any shape is unnecessary, and 
beyond a limited amount does harm. All employ- 
ers of labor on a large scale are now aware that 
even a small quantity of alcohol lessens the endur- 
ance, energy, and cheerfulness of men under hard 
work. A dose of spirits increases the energy for 
a very short time and then leaves more depression 
than before, which a second dose cannot counter- 
act, the best stimulant in these cases being extract 
of beef. Alcohol greatly reduces the power of 
resistance to cold and disease. It is found by 
statistics that total abstainers live longer and arc 
less subject to sickness than other persons. There 
are some, however, chiefly those of weak languid 
circulation, with pale face, cold hands and feet, 
who require a moderate amount of alcohol, pref- 
erably light wines. After middle age a large 
proportion are affected with weak or sluggish 
digestion; to them I would advise a very moder- 
ate amount of liquor at meal times. Individual 



24 Br. J. Keari's Lecture*. 

peculiarities must determine the particular form 
in which the alcohol is taken, but in all cases 
(except acute diseases) it must be moderate in 
amount and taken with meals or just after. It 
ceases to do good when it amounts to more than 
two ounces pure alcohol in twenty-four hours. 

Long-continued use of spirits is almost always 
injurious, and it is to be preferred only when it is 
administered in positive disease and under medi- 
cal direction. 

EXERCISE. 

All employed in sedentary occupations should 
endeavor to have at least one hour a day in the 
open air either walking or riding, or, if this is 
impracticable, to use light dumb bells, or prac- 
tice gymnastics. Any action which quickens the 
breathing and pulse is exercise: the object being 
to eliminate the waste products from the blood by 
means of the lungs. Where too much food and 
too little exercise are taken, part of the carbon 
which ought to have been burnt oft from the 
lungs as carbonic acid, is stored up as fat, and 
often in the wrong place. For the weak and 
those above the middle age exercise should be 
gentle and with rests, and not carried so far as 
to give a lasting sense of fatigue. After severe 
and long-continued exertion, the repast should be 
light and digestible, and in continuous exertion 
for many hours light digestible food should be 



Bathing. 2o 

given every two hours to keep a continuous 
stream of chyle coursing into the blood. 

In severe exertion the nervous energy is so far 
exhausted that proper digestion is retarded, and 
the food lies fermenting in the stomach causing 
irritation, or it may be vomited. 

BATHING. 

The body should be washed daily and rubbed 
dry with a towel. With strong people cold water 
should be used except in winter, when a little 
warm should be added to take the chill off. Swim- 
ming both washes and exercises, and should be 
encouraged as much as possible. The length of 
time in the water varies with the person from one 
minute to an hour. After coming out of the 
water the body should be quickly and thoroughly 
rubbed dry, and in the course of a few minutes 
there should be a warm glow of reaction. If the 
body remains chilled, pale, blue, or shrunken, 
the duration has been too long, or the person is 
too delicate for cold bathing. 

The Turkish bath is extremely cleansing, and 
one of the most pleasant ways of getting rid of 
a cold. It is also very useful in rheumatic affec- 
tions, provided there is no heart disease. 

TEETH. 

The preservation of the teeth is a very import- 
ant matter, for if the food is not properly 
masticated the stomach becomes overtaxed, the 



26 Dr. J. Kean's Lectures. 

juices are lessened, and indigestion is often the 
result. A great cause of the decay of teeth is 
small pieces of food sticking between them and 
undergoing fermentation, favored by the heat and 
moisture of the mouth ; the enamel of" the tooth 
softens and finally decays, forming a cavity. To 
preserve the teeth they should be brushed twice a 
day or oftener ; if done regularly there is no need 
for tooth powder, a soft brush and cold water 
being sufficient. Prepared chalk and charcoal 
deserve the preference of tooth powders ; camphor 
water is suitable. 

CLOTHING. 

Individual peculiarities must determine the 
amount ; better too much than too little. Those 
having a tendency to rheumatism or bronchitis 
should always wear flannel or chamois leather 
next the skin, and all should have warm dry cov- 
erings of the feet. 

SLEEP. 

Individual differences in the amount required 
are very great, varying from five to nine, and aver- 
aging about seven, hours in the twenty-four. 

The last heavy meal should be three hours 
before retiring; if digestion is proceeding sleep 
is not refreshing, but a small quantity of food 
assists to procure sleep by withdrawing blood and 
nervous power from the brain. If the mind be 



Medicines. 27 

active and excited as by hard reading, it is useful 
to turn the thoughts to something else for about 
half an hour before going to bed. The mattress 
should be fine horsehair, and the bed clothes 
should be moderate. The bedroom should be 
airy and well ventilated, but free from draughts. 

MEDICINES. 

(See Precautionary Rules, Lecture XVII.) Many 
people are never satisfied without taking drugs 
for every ailment, real or imaginary, and often 
cause serious detriment by persistent use of 
unsuitable remedies. The most frequent cause of 
uneasy feelings, not amounting to positive illness, 
is constipation. The formation of a regular 
habit in soliciting an action of the bowels is 
important ; the , body mechanically and uncon- 
sciously repeats actions which at first proceed 
from the will. If there is a want of due secretion 
by the lining membrane of the bowels, a tumbler 
of cold water in the morning and the use of 
brown bread usually suffice, aided by moderate 
exercise. 

PURGATIVES. 

Where more active treatment is required castor 
oil or the compound rhubarb pill are preferable 
for family use. 

No respectable medical man employs any 
secret medicine. It is the duty of every physician 



28 Dr. J. Kean's Lectures. 

who makes a discovery to publish it at once, so 
that the sick people all over the world may have 
the benefit. 

The chief basis of the whole race of patent 
pills and quack purgative medicines is aloes, 
which is cheap, powerful, and injurious when 
long continued or in quantity; variously com- 
bined with jalap, scammony, colocynth or gam- 
boge, and sometimes a volatile oil, as oil of pep- 
permint, cloves, caraway or aniseed, they are sold 
under various names, as antibilious pills, vege- 
table pills, liver pills, or by the name of the pro- 
prietor, or of some former well-known physician. 

The fault of quack medicines is not always 
that they are directly hurtful — in fact some of 
them are tolerably good preparations — but invari- 
ably false and lying statements, of their effects 
and uses are given, and they are recommended to 
be taken in many cases where they are sure to do 
harm, and in very few indeed do they effect any 
lasting good, as they are always recommended to 
be too long continued even when they are suitable. 

A class of people who show a wonderful want 
of reasonableness are those who, having tried 
some medicine, or seen it tried on some of their 
friends, either of their own accord or a doctor's 
prescription, straightway recommend it to the 
next sick person they meet, without any reference 
to the disease being the same or even at all like 
it For example, the author once prescribed 



Soothing Medicines. 29 

medicine to be taken inwardly for a patient suf- 
fering from nervous debility, and on his next 
visit found that the patient was so pleased with 
his medicine that he recommended it to a friend 
suffering from rheumatism of the knee, over 
which it was applied. 

SOOTHING MEDICINES. 

Long-continued use of any of the narcotic 
medicines, i. e., which procure sleep, is to be 
deprecated. The different preparations of opium 
disturb digestion and lower the general health, 
and are apt to cause a craving for their continual 
use, like a drunkard's craving for alcohol. Con- 
tinued use of chloral, which causes less disturb- 
ance than opiates, weakens the heart and may 
cause death without the dose being increased ; a 
single full dose of a narcotic may cause death in 
weakly people suffering from bronchitis. The 
active principle of most of the soothing patent 
medicines is opium, in small quantity, but 
enough to be dangerous to infants, for whose use 
many of them are advertised as soothing syrups, 
carminatives, etc. Some of these patent medi- 
cines are excellent preparations in themselves, 
but they require to be used with discrimination. 

Plasters, which are sold as strengthening plas- 
ters, porous plasters, poor man's plasters, etc., 
have very few of the virtues claimed for them, 
but by keeping the part at rest and warm like a 



30 Dr. J. Kean's Lectures. 

poultice they do a certain amount of good and 
seldom do any harm. 

DWELLINGS. 

The soil should be well drained, and a damp 
course laid in the walls, that is, a layer of asphalt 
or tiles, which prevents the damp from rising. 
Damp, low-lying houses are a common cause of 
rheumatism and consumption. The windows 
should all be made to open for ventilation, and if 
made of plate glass heat does not pass out so 
readily. They should extend well up towards 
the ceiling, and open from above as well as below, 
in order to give vent to the foul air at the ceiling. 
For a person with delicate lungs a house is best 
heated by a stove in the hall, which should have 
an inner glass door to prevent cold draughts. 

Gas stoves, unless when provided with a chim- 
ney to the open air, are pernicious. Drains 
should not cross a house and should be made of 
glazed tiles. 

All soil pipes, etc., should be properly trapped 
and ventilated to prevent the sewer gases rising. 
To try if it is so, light fires in all the rooms, close 
the doors and windows and all crevices, and as 
the fires exhaust the air, if there is leakage of 
sewer gases the suction of the fires will draw them 
up, and an offensive odor will be perceptible. The 
sewer gases may not be offensive though quite as 
dangerous. The easiest way to detect leakage in 



Dwellings. 31 

that case is to soak some cotton waste in kerosene, 
place it into the end of the soil pipe, and set tire 
to it, when the smell will be detected if the drains 
are defective. The points to be attended to are, 
first, that the house is cut off from the drain by a 
trap ; second, that waste and soil pipes are tight 
and do not permit sewer gases to break into the 
house ; and third, that the production of sewage 
gas be minimized by free ventilation of draius 
and pipes. All schools and large houses should 
be regularly inspected by a sanitaiy eogineer 
once a year or oftener. 



LECTURE II. 

General Diseases— Small Pox.— Chicken Pox.— Measles. 
— Knbeola.— Scarlet Fever.— Cerebrospinal Fever.— 
Typhus Fever.— Typhoid Fever.— Dengue.— Erysip- 
elas.— Mumps.— Whooping Cough.— Yellow Fever.— 
Plague. — Diphtheria. — Relapsing Fever. — Cholera. — 
Influenza.— Pyoemia.— Puerperal Fever. 



GENEEAL DISEASES. 

@£NERAL diseases are such as invade the 
whole body, and are caused by a poison enter- 
ing the system from without, affecting the 
blood more or less; are accompanied by fever, 
tend to run a definite course, and occur epidem- 
ically. ♦ 

For greater convenience of description they 
may be divided into, first, infectious fevers ; sec- 
ondly, non-infectious specific fevers. 

Infectious fevers then embrace a number of dis- 
tinct diseases, the one-half being eruptive the re- 
mainder not, and will be fully treated of under 
their appropriate heads in a subsequent part of 
this lecture. 

As their title well indicates, they embody a 
reproductive power that multiplies after its intro- 
duction into the body, so that the smallest particle, 



Origin. 33 

if it falls in a condition favorable to growth, may 
give rise to a severe attack. 

It should also be remembered that a majority 
of the infectious class, which I shall describe 
further on under their respective heads, mostlv 
afford complete protection from a second attack, 
while the minority rarely exempt a person once 
afflicted with them from a recurrence of the 
same diseases. These latter will also be described 
at length before dismissing the various subjects 
of the present lecture. 

ORIGIN. 

No infectious disease originates of itself; thus 
all infectious diseases are properly parasitic dis- 
eases, the difference being that in diseases usually 
so classed, the animal or plant causing it is of 
sensible size, while in fevers it is of extreme 
minuteness. The analog}' between the cause of 
infectious fevers and seeds, is very close. 

ANALOGY. 

Like the various seeds each infectious disease 
breeds true. Measles produces measles, and small 
pox produces small pox, etc. 

Each has its own well-marked type, some attack- 
ing one part of the body more especially, and 
some another, having a more or less definite 
period of incubation or hatching, increase and 
decline. 

In the majority of infectious fevers, one attack 

3 



34 Dr. J. Kean-a Lectures. 

usually exhausts the liability of the body to that 
disease, and when a second attack does occur it is 
usually much milder. 

Different epidemics of the same disease may be 
supposed to be analogous to different varieties of 
seeds : thus one variety grows quicker and heavier 
than another. So in one epidemic the symptoms 
are very severe, and a great proportion of those 
attacked die, while in another the symptoms are 
mild and deaths very few. 

CONSTITUTIONS. 

The different constitutions and conditions or 
surroundings, may be supposed analogous to the 
different soils ; one person easily taking infection 
and suffering severely, while another appears 
absolutely incapable of taking it. The predispo- 
sition to take one disease may be very great, and 
yet there may be great resistance to all others. 
People in strong health as a rule offer great resist- 
ance to all diseases; possibly the vigorous life 
throughout the body does not easily allow the 
growth of germs, while weakly people offer less 
resistance. Infectious diseases often run in cycles ; 
for example, whooping cough prevailing one year, 
and scarlet fever the next. 

From the foregoing considerations we shall 
have an intelligent idea of the reason of our 
treatments, and fresh details will suggest them- 
selves according to circumstances. 



Ham dens Germs. 35 

HARMLESS GERMS. 

Besides the germs which produce infectious 
diseases, the air is always more or less loaded 
with comparatively harmless germs which cause 
the putrefaction of dead matter, and which if they 
fall upon a wound may manufacture from the 
secretions a poison which may be taken into the 
blood and cause a disease called septicaemia ; this 
poison does not multiply within the system, but 
unless the production in the wound be arrested, 
enough will be formed to kill the patient. May, 
without producing any definite poison, give origin 
to substances which irritate the wound, and so 
delay or prevent its healing, and cause it to dis- 
charge pus (matter). Antiseptic surgery accom- 
plishes this, either by denying germs access to 
the wound, or by killing them by poisoning 
before they reach it. 

Germs cause their evil effects in two ways : 1st 
by their growth, depriving the cells and tissues of 
the body of their proper nourishment; 2d by 
forming chemical compounds which act as pois- 
ons or irritants. All putrefactive germs do not 
require the same conditions for growth as large 
animals ; one at least flourishes in hydrogen and 
cannot live in oxygen. Germs cannot grow in a 
single element nor in a mixture of several elements 
which do not chemically combine. 

Preventive Treatment. — In preventing the 
spread of infectious diseases we use exactly the 



36 Dr. J. Kearts Lectures. 

same precautions we should take to destroy the 
vitality of seeds, remembering that some are very 
hard to kill, and if a single one escapes the mis- 
chief may begin again; hence we see the import- 
ance of thoroughness, though less perfect means 
are of use, as the undestroyed germs may not fall 
in a position favorable to growth, and we know 
that in many cases, not one seed in a thousand 
reproduces its kind. 

HEAT. 

To destroy the vitality of seeds we may use : 
Kiln-drying, that is baking at a high temper- 
ature ; exactly the same measure, baking for two 
hours at 250°F., destroys infection germs. Two 
hours may seem a long time, there being no harm 
in the germs being overcooked, but there is great 
danger of their being underdone. The vitality of 
a few seeds and germs resists the temperature of 
boiling water (212°F.) without being destroyed. 

Again, to destroy the vitality of seeds, we may 
use: 

DISINFECTANTS. 

There is a very prevalent error that all deodor- 
ants are also disinfectants; but this is by no 
means the case : thus freshly roasted coffee is a 
capital deodorant, but it is not a disinfectant 

Cold arrests the growth of seeds and germs; 
hence diseases, the germs of which multiply out 
of the system, such as cholera and yellow fever, 



Vitality. 37 

are more prevalent in summer and in hot climates 
than in winter and cold climates. 

VITALITY. 

Seeds when kept dry and Dot much exposed to 
the air retain their vitality for centuries. From 
this we may also understand how a healthy person 
may convey infection by his clothing and yet 
never be sick himself. 

CONTAGIA. 

The contagia or disease germs are usually given 
off in greatest abundance by the organs most im- 
plicated, and towards the end of the attack ; thus 
from the emanation from the lungs in whooping- 
cough, from the false membrane in the throat in 
diphtheria, and from the discharges from the 
bowels in typhoid fever and cholera. 

Some disease germs, whose local action is 
chiefly on the bowels and stomach, viz., cholera, 
typhoid and yellow fevers, multiply out of the 
body, or at least remain in vigorous vitality in a 
suitable soil; hence the importance of having 
soil pipes properly trapped, cesspools removed, 
and cleanliness generally, not only because filth 
is injurious in itself, but because it furnishes a 
breeding-place for disease germs. 

INFECTION. 

The modes of infection are three in number : 
1. Disease germs may be inhaled and enter the 



38 Dr. J. Keari's Lectures. 

blood by the lungs and air passages, as in most 
of the fevers; for example, whooping-cough, 
mumps. 

2. Disease germs may be swallowed with the 
food or drink, usually the case in typhoid fever, 
the germ being contained in drinking water or 
milk. 

3. By direct application to the broken skin or 
thin mucous membrane, rare in fevers but occa- 
sionally seen in erysipelas. 

PRECAUTIONS. 

1. We should not remain long in a sick room 
without going into the open air. " Dilution with 
abundance of fresh air destroys the germs." 

2. When in the sick room avoid breathing the 
patient's breath or standing in the draught from 
him to the fire-place. 

3. Eat and drink nothing that has not been 
boiled some time, and have all cups and dishes 
washed in boiling water or water that has been 
boiled. 

4. Avoid touching the secretions, and use 
plenty of soap and water or carbolic acid and 
water. 

When, unfortunately, we have to do with an in- 
fectious disease, the following precautions should 
be used to prevent its spreading. 

1. The sick room should be at the top of the 
house, and should be well lighted and ventilated. 



Precautions. 89 

2. The patient should be isolated, no one of 
the household but the nurse being allowed in. A 
sheet should be fixed outside hanging down over 
the sick-room door, and moistened from time to 
time with carbolic acid, two tablespoonfuls to a 
quart of water ; or with permanganate of potash. 

The object of the sheet is to destroy any germs 
which may pass through the door, and as carbolic 
acid is volatile, it is to be preferred ; but if the 
odor is objectionable, permanganate of potash, 1 
to 50, though not so effective, is useful and odorless. 

The nurse should wear some smooth washable 
material, and should have a wrapper or dressing- 
gown to be worn in the sick room and left in it 
when she goes out. 

Precautions as to the patient — oiling the skin, 
etc., will also be given under each disease. 

In infectious fevers where the outer skin peels 
off, as scarlet fever, when the skin begins to peel 
the whole body should be thinly anointed with 
carbolic oil, 1 to 40, which may be washed off and 
reapplied every day; the object being to clog the 
scales of skin and prevent them flying about and 
so becoming a source of infection. When the 
skin ceases to peel the oil may be finally washed 
off in a warm bath of carbolic acid — two ounces 
to three gallons of water. If cold water is used, 
the carbolic acid must be increased to 1 to 160. 
Soiled linen should be at once put into carbolic 
acid and water — 1 to 40 — till convenient to wash. 



40 Dr. J. KearCs Lectures. 

In cholera, typhoid fever, and yellow fever all the 
discharges should be disinfected by putting car- 
bolic acid into the bed pan before using, and the 
stools, etc., after being disinfected, buried away 
from wells or running water, or mixed with a 
larger quantity of crude carbolic acid, say three 
tablespoonfuls, before being sent down the water- 
closet. The patient should expectorate into a 
vessel of carbolic acid, and all dishes used by 
liim should be disinfected either by boiling water 
or carbolic acid. 

3. After the disease is over, the sick room and 
contents must be thoroughly disinfected. All 
blankets, books, and small articles should be 
baked two hours at a temperature of 250°F. ; this 
may be done by putting them in a wooden box 
into an ordinary oven. The patient's linen, after 
being disinfected, should be scalded or boiled 
and washed. White woolen articles can be baked 
for two hours at 250° F. without any change 
except a slight discoloration like that produced 
by washing new flannel. The strength of texture 
and warmth of blankets are not affected. Cotton, 
silk, linen and paper are not affected by a 
longer time. At 300°F. white woolen articles are 
singed, and colored wool loses its color, but its 
strength is little affected. When hair mattresses 
are baked they should be allowed to stand for 
two days before making up again, so that they 
may recover their natural moisture and not cause 



Precautions. 41 

dust. The sick room itself must be disinfected, 
the atmosphere and inaccessible places by disin- 
fectants in the shape of gas, of which sulphurous 
acid and chlorine are the most common, cheapest 
and best. The furniture and accessible parts of 
the room are more thoroughly disinfected by dis- 
infectants in the shape of fluids, of which carbolic 
acid, permanganate of potash, chloride of zinc, 
and boiling water are the most common ; carbolic 
acid is neutralized by most of the fluid disinfect- 
ants, and should always be used alone. 

Remove all bright steel or metal articles from 
the room. Paste up all chinks oi windows, fire- 
places, etc., with paper. Place a pail of water iD 
the middle of the room, covered by an iron dish, 
with half a pound of sulphur; set fire to the 
sulphur and shut the door for a night. Any dis- 
infectant vapor so weak that it can be breathed 
even for a single instant is of no use ; hence it is 
useless to expose saucers of carbolic acid in the 
sick room ; the vapors merely annoy the patient 
and do no good. 

Next day the floors should be washed and 
scoured or scalded if practicable. The walls lime- 
washed, or if varnished washed with soap and 
water. The bedstead and furniture should be scald- 
ed or washed with carbolic acid, soap and water. 
Finally the doors and windows should be left open 
for a few days. When these precautions are thor- 
oughly carried out there is no danger of infection. 



42 Dr. J. Kean y s Lectures. 

Curative Treatment. — The cells which form 
the tissues of the body have a separate local life 
of their own, and when removed under the mi- 
croscope live for hours if kept at a proper tem- 
perature. 

Death of the cells singly is seen in an ulcer ; 
death of a mass of cells is mortification. Our 
object then is to poison the germs without also 
destroying the tissue cells; unfortunately in all 
the infectious diseases we are as yet unable to do 
this; we can merely prevent complications, and 
mitigate the severity of the disease ; in short, we 
can guide, but not stop the disease. 

In malarious diseases, on the other hand, we 
have such poisons in quinine, salacine, etc., and 
are usually able to stop the disease, quinine, etc., 
being poisons to those low organisms and a tonic 
to the tissues. Though quinine kills the germs 
and stops the disease, it does not undo the mis- 
chief which has already been done, such as 
enlarged liver, spleen, etc. 



8 I Boom. 43 

GEXERAL TREATMENT OF 
FEVERS, 

SICK ROOM. 
The sick room [see Figure 3] should be at 
the top of the house. It should be tolerably 
large, with a southern exposure, neither apt to be 
unduly heated by the rays of the sun. nor ren- 
dered dull from it- absence. The ventilation must 
be thorough, but no draughts. The room should 
have a rireplace with a good fire in cold weather, 
and open in warm weather to assist ventilation. 
It is desirable to have a small room in immediate 
connection with the sick room, for the nurse 
sleep in. and cany on the various little operations 
in preparing food and medicine without risk of 
annoj in^: the patient. The temperature of the 
room should be kept between 00° F. and 65° F.. 
f the lungs, when it should be 
65° F. to 7t) : P. night and day. and a thermome- 
ter hung up out of draught- or the direct reach of 
the fire to indicate the temperature. 

BED. 
Should not be in a draught, as between the door 
or window and rireplace. The patient should lie 
with his back to the window. A hair mattress is 
the m«>st suitable, and the amount of bed clothing 
regulated by the feeling- of the patient, but little 
or mnch. it must be even, and no part of the body 

except the head left UHCOVe 




Fig. 3.— Sick Room. 



Nursing. 45 

NURSING. 

Faithful nursing is of the utmost importance ; 
in severe fevers making the difference between 
life and death. To be a thorough nurse requires 
both natural tact and training, or experience. 
For slighter cases tact and sympathy are more 
important; for severer cases, training; for both, 
constant attention both day and night. 

The nurse should dress in quiet, neutral colors ; 
bright colors are distressing to the eye, while 
black is depressing, and may be the traditional 
last straw. 

Everything must be done for the patient with- 
out being asked, to avoid worrying him with 
questions, and forcing him to make up his mind. 

Light. — The light should be subdued by win- 
dow-blinds. 

Quiet. — The sick room should be quiet; no 
rustling dresses, creaking boots, or crackling 
newspapers should be allowed. All speaking 
must be gentle but distinct, and no whispering 
allowed. 

Rest. — The patient should be disturbed as little 
as possible. 

Cleanliness. — The personal and bed linen 
should be frequently changed. The mouth should 
be often wiped with a soft wet towel when there 
is a crust on the teeth and lips. The body should 
be sponged over at intervals with tepid or cold 
water, whichever is preferred by the patient, and 



46 Dr. J. Keaii's Lectures. 

quickly dried with, a soft towel. When there is 
delirium or apathy, the bladder must be emptied 
at least twice in twenty-four hours, and the nurse 
must see that it is so, as mischief may be clone by 
the retained urine. The discharges must be 
washed off, and bed-sores looked for. 
BED-SORES. 

In severe or long-continued illness, the parts 
where the chief pressure is begin to lose their 
vitality ; there is a slight reddening of the skin, 
which begins to look glazed like parchment, and 
if not arrested the part dies, and is thrown off, 
leaving a bed-sore, which is very troublesome and 
even dangerous, by reducing the patient's strength. 
When the skin looks threatening it should be kept 
dry, and painted over twice a day with collodion 
or white of egg beaten up with spirits of wine, 
and the pressure relieved by a circular air pillow 
or a nest of cotton wool with its two ends tied to- 
gether to form a circle. 

Blisters are dangerous because they are apt to 
leave sores. 

Reduce the excessive heat, by sponging the body 
with cold or tepid water and quickly drying with 
a soft towel. 

In some cases the cold bath may be required, 
and, to be of use, must be employed when the 
temperature rises to 103° F. or more before the 
third or fourth day of the fever. The water 
should be at 95° F., and gradually cooled down to 



Food 47 

60° F. by addition of cold water. The time is 
regulated by the result, but rarely more than 
twenty minutes. The patient is then dried and 
put to bed with a hot brick at the feet. The cold 
bath is a very dangerous remedy and requires 
great caution, as the temperature goes on decreas- 
ing after the bath, and has caused many deaths by 
weakening the patient too much to recover ; so 
much so, that one of the first physicians who in- 
troduced it was afraid that in removing one dan- 
ger he had introduced another. 

When the head symptoms are severe, a pail of 
cold water poured from a height of about two 
feet often gives great relief, but is dangerous, and 
must be cautiously used. 

The good effects of cold are seen in slower 
pulse and breathing, reduced body heat, soft 
moist tongue, diminished stupor, refreshing sleep 
or perspiration, which may bring relief. 

Secure sufficient action of the kidneys, skin, and 
bowels ; but diarrhoea or sweating requires to be 
checked. 

Sustain and stimulate the exhausted semi-paral- 
yzed nervous system by food and stimulants. 
FOOD. 

Must be nutritious and easily digested and be 
given in small quantity at frequent, regular inter- 
vals. The smaller the quantity the more frequently 
it must be given. 

The intervals may vary from one to four hours ; 



48 Dr. J. KeanSs Lectures. 

the severer the disease the more frequently food 
must be given. 

Chief of all is milk, natural or boiled; when 
it feels heavy, soda water or lime water must be 
added. Beef-tea, eggs, soups, broths, rice, corn- 
flour, and milk flavored and sweetened with essen- 
ces, spices or jellies, are all appropriate and valu- 
able articles of food. The following recipes for 
restorative beef-tea will be found of use : — 

Lean meat is finely minced, mixed with an 
equal weight of cold soft water, and slowly heated 
to boiling; boil for one minute then strain it 
through a cloth, flavor it to taste. It forms a color- 
less and pleasant beef-tea. 

Take % of a % of raw beef or chicken, mince 
it finely, and mix it with fourteen ounces of cold 
distilled water, or rain water, add four drops of 
hydrochloric acid, and let it stand for an hour at 
blood heat or not above 116° F. Strain it through 
a hair sieve, and wash the residue on the sieve 
with five ounces more of distilled water, which 
gives nearly a pint of very nourishing beef-tea. 

Soak one lb of finely minced beef for an hour 
in one pint of cold water, heat it slowly, and boil 
for a quarter of an hour ; strain off the liquor, 
which is an excellent soup. 
DRINK. 

Best of all is pure cold water. Barley water, 
lemonade, toast water, gruel, cold tea without 
milk or sugar, cream of tartar a teaspoonful to a 



Alcohol 49 

pint of boiling water with lemon and sugar — all 
may be tried by turns, drinking small quantities 
aDd often. All drinks may be taken iced if de- 
sired by the patient. 

ALCOHOL. 

Alcohol must be used with caution, and may 
easily be overdone. Our object is to keep the 
patient alive from hour to hour till the disease 
has time to run its course. 

Indications for its use. — A very slow pulse ; 
soft, irregular or intermitting pulse ; burning dry 
skin; profuse perspiration and no improvement 
of the symptoms; dry brown tongue; coldness 
of the limbs ; low muttering delirium. 

Indications against its use. — Acute noisy 
delirium ; severe darting headache along with a 
hot, dry skin ; flushed face ; suffused eyes ; strong 
pulse; suppression of urine; delirium increased 
by its use. 

Good effects are shown by the quick pulse 
becoming slower; the tongue clean and moist 
at the edges ; restlessness and delirium replaced 
by rest and tranquillity. 

Whiskey or brandy, with an equal quantity of 
hot milk or water, are to be preferred during the 
fever ; two teaspoonfuls of the mixed fluid every 
hour, up to a tablespoonful, which is a full dose. 
If alcohol is required during convalescence, light 
wines are to be preferred. The dose should be 
reduced as soon as the symptoms yield. 



50 Dr. J. Kearts Lectures. 

MEDICINES. 
Camphor-water is useful as a stimulant in low 
forms of fever, but large closes of carbonate of 
ammonia are hurtful. Except quinine and sala- 
cine, in ague there is no direct curative medicine, 
and unnecessary drugging is to be avoided. 

TO RELIEVE DISTRESSING SYMPTOMS. 

Headache. — Headache at the beginning of a 
fever may be relieved by action of the bowels, 
afterwards by evaporating lotions, such as vinegar 
and water, or by ice to the shaven head ; a single 
dose of quinine, combined with capsicum, is 
sometimes effectual. In old people warm fomen- 
tation to the head may be better than cold. 

Sleeplessness. — Sponging the face and hands 
with tepid water, or if necessary, opiates, 1 grain 
of opium (not in children), repeated in four hours 
if necessary, or chloral hydrate, 10 grains (not 
with heart disease), may be used. 

Swollen Abdomen (Tympanites). — A turpen- 
tine cloth over the abdomen, and turpentine, 3 
drops in water, taken. 

Hiccough may be relieved by sucking ice. 

Vomiting may be relieved by sucking ice, or 
by creosote, 1 grain, repeated if necessary. 

Convalescence. — The diet must be carefully 
regulated ; the patient often feels ravenous, and 
is inclined to eat to excess. The food should be 
digestible and nourishing. 



Variola. 51 

I> FECTIOUS FEVERS. 

VARIOLA.— (Small Pox.) 

This disease is eruptive, and usually protects 
from second attack. 

1st Stage. — About twelve days after exposure 
to infection the fever begins with chills, shiverings, 
flushes of heat, weariness, sickness, headache, 
pain in the back, which is severe and like that of 
a sprain, and is characteristic of small pox. 
There is great thirst, with white tongue, a slimy 
taste in the mouth, and vomiting, the persistence 
of which indicates a severe attack. The face is 
suffused with red, and the great arteries of the 
neck throb. The eruption can be felt beginning 
under the skin like grains of small shot. The tem- 
perature is very high, (104° to 106° F.) ; each morn- 
ing there is a slight remission, i. e., the fever is a 
little less, but the evening fever goes on increasing 
till the evening of the third day, when it suddenly 
falls from 106° to 100° F., when the eruption 
appears. 

2d Staoe. — The eruption appears first and most 
abundantly on the face, the next day on the neck 
and trunk, and the following day on the lower 
limbs. It consists of small red pimples number- 
ing from tens to thousands, which gradually en- 
large and ripen into vesicles or little blebs filled 
with a clear fluid. Each vesicle is composed of 
several compartments like the space between the 



52 Dr. J. Kecm's Lectures. 

spokes of a wheel, and is depressed in the centre. 

3d Stage. — About the fifth or sixth day of the - 
eruption the vesicle enlarges, the contents become 
cloudy, or like whey, the center becomes prom- 
inent and the divisions are lost, so that if punc- 
tured all the contents escape, and are now a thick 
pus, whence it is called a pustule. The skin 
around each forms a dark red in flamed ring, and 
is much swollen, giving severe tense throbbing 
pain. Along with the formation of pustules there 
is the peculiar small-pox odor, and the secondary 
fever begins, which reaches its height in about 
three days. 

4th Stage. — About the eighth or ninth day of 
the eruption the pustules begin to ripen and burst ; 
the contents forming soft yellowish crusts, and 
along with walls harden into brown scabs which 
begin to fall off in three or four days, leaving 
purplish red spots which are* a little elevated, 
while the skin remains swollen, but finally disap- 
pear leaving no mark. Where there has been 
ulceration of the skin, the crusts remain long ad- 
herent, and when they separate ieave round deep 
pits, at first red, but becoming white, and which 
last during life ; even in severe cases many scabs 
leave no permanent pit, and in the mildest cases 
a few are apt to ieave deep pits. Picking off the 
scab increases the inflammation, and leaves per- 
manent marks, where, if left alone, there would 
be none. 



Variola. 53 

The eruption is always closest on the face, and 
in advance of the rest in its progress, the change to 
vesicles often beginning at the same time that the 
eruption begins to come out on the lower limbs. 

The severity of the disease is in direct relation 
to the quantity of the eruption; in very mild 
cases there being only a few separate spots with 
sound skin between, while in severe cases they 
run together (confluent) so that the face seems one 
huge blister; in these cases the skin is usually 
destroyed to some depth, and leaves scars like a 
burning (cicatrices). In fatal cases death gene- 
rally occurs at the height of the secondary fever 
as the pustules begin to break. 

The eruption on the mucous membranes causes 
man} r distressing symptoms from the time of be- 
coming vesicles till the pustules begin to break. 

Those in the mouth cause increased flow of 
saliva which constantly trickles down. Those in 
the throat (pharynx) cause difficulty, almost im- 
possibility, of swallowing ; those in the air pas- 
sages cause hoarseness, cough, and sometimes 
spitting of blood ; those in the eyelids and eyes 
(conjunctivas) cause burning, watering, and sensi- 
tiveness to light. There may be also pain and 
difficulty in passing water, etc. 

The contagion of small pox is the most power- 
ful and certain of all fevers. The period of infec- 
tion commences with the eruption, and continues 
till the last scab falls oft. 



54 Dr. J. Kean's Lectures. 

The same precautions are to be used in the sick 
room during the disease, and disinfection of the 
room and contents afterwards, as in scarlet fever. 

Curative Treatment. — Eest in bed in a room 
kept about 60° F., slightly darkened. 

HOT STAGE. 

Take 

Tincture aconite root, 30 drops. 

Tincture belladonna, 15 drops. 

Water 2 oz. 

Mix. 

Dose — One teaspoonful in water every hour. 
This will relieve pain in a few hours, and then 
continue belladonna alone in the same dose, to 
develop rash effectually. This done, 
Take- — 

Chlorate potash, % oz. 

Water, % pint. 

Mix. 

Dose — Teaspoonful every few hours. - Or — 

Take 

Oil turpentine, % oz. 

Oil olive, 2 oz. 

Mix. 

Make an emulsion, and take % oz. every few 
hours. If mucus be present in mouth or throat, 
give in a single dose, the following : 

Take 

Acetic tincture of blood root, % oz. 

Tincture of lobelia, 3€ oz - 

Mix. 

If bowels be constipated regulate by a gentle 
laxative, and while thus moved, give quinine, 3 



Variola. 55 

grains, or salacine, 3 grains, to tone up the system. 
(See precautionary rules, Lecture XVII.) 

In some cases shave the head, and apply cool- 
ing lotions, vinegar and water or ice. In ail the 
hair should be cut short to prevent matting. If 
there are delirium and restlessness, opiates, pro- 
vided there is no spitting of phlegm; when there 
is mucus a strong opiate might cause suffocation 
by allowing it to accumulate and choke up the 
air passages. Bed-sores must be looked for and 
painted over with white of egg and brandy or 
whiskey. No secondary fever will follow if these 
directions are faithfully carried out. 

If the secondary fever should present itself: 

Take 

Snip, quinine, 10 grains. 

Pulverized capsicum, 3 grains. 

Mix. 

Make three powders, and administer one every 
two hours (see precautionary rules, Lecture XVII,) 
till the fever yields or till it is given three times, 
and mild laxatives if there is not free use of the 
bowels. 

Local Treatment. — To prevent pitting, apply 
externally : 

Take 

Lard, 1 oz. 

Powdered charcoal, 1 oz. 

Thoroughly mixed. 

And if the pustules are many apply cold water 
cloths over them, to restrain the inflammation and 
protect the parts from atmospheric air. 



56 Dr. J. Kean 1 s Lectures. 

Preventive Treatment. — Vaccination or a 
previous attack of small pox or cow pox gives 
almost complete protection ; when there is a sec- 
ond it is usually very mild. 

VACCINATION 

Is merely a variety of small pox, modified by 
being passed through one of the cow tribe, and 
gives more complete protection than even an 
attack of unmodified small pox. 

Previous to the discovery of vaccination, inoc- 
ulation with small-pox matter was practiced, 
which usually, but not always, gave rise to a mild 
attack. In many instances it produced a severe 
attack, and caused the death of the patient or led 
to a severe and fatal epidemic, the small pox pro- 
duced by inoculation being quite as infectious as 
that caught by infection. 

It is now illegal to practice inoculation. In a 
small pox hospital it was found that one in three 
of the unvaccinated died, while of the compar- 
atively few who were vaccinated, and yet took 
small pox, only one in fifteen died. 

If a calf is inoculated with small-pox matter 
from a human being, it suffers from an attack ol 
cow pox. and if in turn a human being is inoc- 
ulated from it as in ordinary vaccination, we have 
many of the characteristic marks of ordinary 
mild small pox; the inoculated point going 
through the changes of pimple, vesicle, pustule 



Vaccination. 57 

and scab, with a certain amount of fever, and 
giving protection from a subsequent attack of 
small pox, but with two most important points of 
difference : 1. The fever is always comparatively 
slight, as we should expect in small pox where 
there was only one to four spots of eruption. 2. 
It is not infectious, requiring to be applied to the 
broken skin in order to cause an attack. 

The vaccine matter having once been modified 
in passing through the cow, remains so in passing 
through an indefinite number of human beings. 

The protective power of vaccination seems to 
some extent to depend on the severity of the 
attack; hence, as the eruption is only at the inoc- 
ulated points, it is usual to vaccinate in three or 
four places. Vaccination does not cure small 
pox, but merely exhausts the predisposition to 
take infection ; in some instances, both have run 
their course together. In time the protective in- 
fluence seems to wear out; hence children who 
have been vaccinated should be revaccinated 
wmen grown up. 

All children are, in most states, required b} r 
law to be vaccinated within three months of 
birth unless the child is not in a fit state of health 
for the operation. 

The middle of the upper arm is the place 
usually selected. The skin is cut to a slight ex- 
tent, barely sufficient to draw blood, in three or 
four places, and the vaccine virus applied ; on the 



58 Dr. J. Kean } s Lectures. 

third day after the operation pimples rise on the 
inoculated spot, and about the sixth day change 
into vesicles. On the eighth day the vesicles are 
at maturity, having several compartments and a 
central depression. The vaccine lymph »may be 
taken off by cutting the top of the vesicle in 
several places with a lancet, or piercing it with a 
needle, being careful to avoid touching the in- 
flamed base or drawing blood. The lymph should 
be clear like water; if cloudy or mixed with 
blood, it should be rejected; and may be pre- 
served by sealing in small glass tubes, or dried 
upon ivory points, or simply preserved between 
two slips of glass ; one is laid over the vesicle till 
the lymph touches it, and it is then covered with 
another. When about to be used the glasses are 
separated and one breathed on, the resulting 
moisture is scraped off with a lancet and laid on 
the broken skin. 

The lymph should be taken on the seventh or 
eighth day, from a healthy child who has not 
previously been vaccinated, and is best used at 
once arm to arm. 

Any rubbing or bruising of the base of the ves- 
icle causes it to inflame, leaving a painful swollen 
arm; to avoid rubbing, the sleeve should be 
looped up. 

On the ninth day the contents of the vesicle be- 
come cloudy, and by the tenth consist of pus 
which bursts the pock and oozes out, forming a 



Varicella. 59 

scab that falls off in the course of the third week, 
leaving a scar marked by a number of distinct 
pits, evidence of successful vaccination. 

In a second vaccination, as in mild small pox, 
the changes are much quicker. During the 
course of vaccination the nearest glands swell, 
and there is fever which may have a temperature 
of 104° F. It is sometimes followed by some 
affection of the skin, but which is of short dura- 
tion. 

As in all fevers, though to a much less degree, 
there is a shock to the constitution. In very deli- 
cate children there maybe skin diseases lasting for 
months, but which may also be produced \}y 
other causes, as teething, weaning, or having the 
ears pierced. 

VARICELLA.— (Chicken Pox.) 

This is eruptive, and like small pox protects 
against second attack. Its chief importance is 
from its resemblance to mild cases of small pox. 

About four days after exposure to infection, 
discomfort, loss of appetite, headache, and some- 
times chilliness and pains in the limbs, precede 
the slight fever, with a pulse of 90° to 100° 
usually. WTien the fever has lasted one 
to three days the eruption appears as little 
pimples, which in a few hours change to limpid 
vesicles the size of a pea, looking as if the skin 
had been sprinkled with boiling water, causing 



60 Dr. J. Kearts Lectures. 

small blisters. The vesicles have no central depres- 
sion and are not divided into compartments. The 
contents soon become cloudy like whey, but do' 
not go on to form pus; on the third day the 
vesicles burst and dry up, and in four or five days 
the crust falls off, leaving a red spot, but no pit 
unless it has been irritated or inflamed. Success- 
ive crops of vesicles come out every twenty-four 
hours, and may continue forming for ten or four- 
teen days, so that pimples, vesicles, and scabs 
may be found all together. 

An attack of chicken pox occurs as a rule only 
once, usually in young children. It does not pro- 
tect from small pox. 
Treatment. — Inflammation (hot stage) : 

Take 

Tincture aconite root 20 drops. 

Fluid extract belladouna 10 drops. 

Water 3 oz. 

Mix. 

Dose — One teaspoonful every half hour. 
Will produce rash in twenty-four hours instead 
of the required time of forty-eight hours or 
longer; after the appearance of a full crop ot 
pustules, give gentle cathartic, snch as : 

Take 

Jalap % grain. 

Senna % grain. 

Mix. 

And use at one dose. 

Also, quinine or salacine in 1 grain doses every 
two hours for six hours. 



Rubeola Vulgaris. 61 

Milk diet and stewed fruit, but no animal food ; 
if there is much fever, cooling drinks. 

The child should be prevented from picking off 
the scabs, lest there should be marks left by the 
inflammation caused thereby. 

Convalescence. — In weakly children iron 
tonics. Muriate tincture, 3 to 5 drops in water, 
thrice daily, is the best; continue for three or 
four weeks. 

RUBEOLA VULGARIS.— (Measles.) 

Another of the eruptive class, seldom attacking 
the second time. Ten to fourteen days after 
exposure to infection the fever begins sud- 
denly, like a severe cold in the head, with 
chills, shivering, and flushes of heat, sneez- 
ing, watering eyes and running nose, and a 
short hoarse cough. The skin feels hot, and the 
temperature is high (101 to 103); some sore 
throat or diarrhoea may be present. 

Eruption. — On the fourth day of the fever the 
characteristic eruption appears, first on the chin 
and face, and extending to the trunk and limbs. 
It consists of little spots of a raspberry color, of 
the size of millet seeds, and forms irregular cres- 
cent-shaped patches which disappear on pressure, 
but soon return. It lasts out four or five days, 
and is succeeded by desquamation — the scarf skin 
coming off in branny scales. The fever continues 
to increase till the eruption is fully developed, 



62 Dr. J. Kean's Lectures. 

when in favorable cases it begins to decline. The 
perspiration after the eruption appears has a 
peculiar odor. The whole duration of the fever 
is generally nine to eleven days. In some cases, 
as in scarlet and typhoid fevers, there is no 
eruption. 

The chief danger is from cold, causing bron- 
chitis or pneumonia (inflammation of the lungs), 
and it is apt to be followed by consumption 
(destructive diseases of the lungs), or by inflam- 
mation and running from the ear, eye or nose ; by 
enlargement and inflammation of the glands of 
the neck, by inflammation of the bowels, or by 
Bright's disease (acute disease of the kidneys). 

Treatment. — Incubation, or first stage : 

Take 

Turpentine emulsion 3 oz. 

Tincture gelseminum 20 drops. 

Mix. 

Dose — One teaspoonful every three hours. 
Congestive, or cold stage: Apply blankets 
wrung out of mustard and hot water. 

Inflammation, or hot stage : 

Take 

Tincture aconite root 24 drops. 

Fluid extract belladonna 6 drops. 

Water 3 oz. 

Mix. 

Dose — One teaspoonful every hour until the 
rash is fully developed. (See precautionary rules, 
Lecture XVII.) 



Scarlet Fever. 63 

Even temperature of 60° F. to 65° F. day and 
night. Ventilate the room twice a day, laying a 
thin cloth over the head and face of the patient. 
Watch constantly lest the cloths be thrown off, or 
the neck and arms left uncovered. The whole 
body must be covered even if only with a single 
sheet. 

Diet. — Should be milk, warm, if possible, from 
the cow, and stewed fruit ; no animal food. 

Pure cold water ; acid drinks slightly sweetened ; 
oranges, and lemon juice are eagerly taken. 

If the cough is severe, small doses syrup of 
tolu should be given, but in mild cases drugs are 
superfluous. 

Convalescence. — The patient should remain 
in bed, or be confined to the room, till the cough 
ceases and the skin has ceased to come off' in 
scales. Quinine and iron with nourishing food 
should be given for some time after the fever is 
over, averaging about three weeks. Three grains 
of citrate of quinine and iron to be taken thrice 
daily. 

Different epidemics vary very much ; in some 
the attack is very severe, and many deaths occur, 
but generally the attack is slight and deaths few. 

SCARLET FEVER. 
Symptoms. — It is rarely found to attack the 
same person a second time; is also eruptive. 
Four to nine days after exposure to infection the 



64 Dr. J. Kean's Lectures. 

disease commences with weariness, sickness, pain 
in the back and loins, chills, shiverings, headache, 
loss of appetite, often vomiting. The tongue is 
coated with a creamy white fur, and has a vivid 
reel tip; projecting through the white fur are 
numerous bright reel spots (papillae) like the seeds 
of a strawberry — hence called the strawberry 
tongue — which is characteristic of scarlet fever, 
though seen in other diseases. 

The throat feels sore, and is bright red inside at 
the back. 

Eruption. — On the second day of the fever the 
eruption appears, consisting of minute red spots, 
which increase in number till the skin assumes a 
scarlet color. The color is brightest at the joints, 
and disappears on pressure, but soon returns. 
The skin feels hot and burning to the hand, the 
temperature being 104° F. to 105° F. or more, and 
the higher it becomes the more serious is the 
case. The pulse is 120 to 130 beats per minute. 

From the fifth to the seventh day of the fever 
the eruption begins to fade, and is succeeded by 
the skin peeling off in small branny scales over 
the body, but in flakes on the hands and feet 
(desquamation), and may last for several weeks. 

Scarlet fever is usually divided into three 
varieties. 

Varieties. — 1. Simple, where there is no rash 
nor sore throat, and often only recognized by its 
after effects. 



Savrlet Fever. 65 

(Most common) Scarlet rash and sore throat, but 
no ulceration (Scarletina). 

2. Anginose. Sore throat ulcerated and ten- 
dency to form abscesses in the neck. 
. 3. Malignant. The throat tends to slough, 
i. e., portions of tissue die bodily, scarlet rash 
scarcely visible and dusky colored, or there is 
none ; black patches of blood under the skin, and 
the delirium of the fever is of the low muttering 
exhausted kind. 

The chief dangers are from causing kidney 
disease and dropsy, or rheumatism. Scarlet 
fever is very treacherous ; even after the mildest 
cases, and the lapse of some weeks, there may be 
affection of the kidneys. 

Diagnosis. — The most likely diseases to be 
confounded with it are measles, diphtheria, and 
typhoid fever. 

TREATMENT. 

Take 

Tincture aconite root 15 drops. 

Fluid extract belladonna 15 drops. 

Water 2 oz. 

Mix. 

Dose — Teaspoonfui every two hours, in water. 

And apply to throat, from ear to ear, the 
following : 

Take 

Olive oil 2 oz. 

Oil turpentine \ % oz. 

Mix. 

5 



66 Dr. J. Keari's Lectures. 

When inflammatory symptoms attack the 
throat, use as a gargle, or apply with a swab : 

Take 

Chlorate potash % oz. 

Hot water % pint. 

Mix. 

Or apply with atomizer weak solution of bap- 
tisia tinctoria. (See precautionary rules, Lecture 
XVII.) 

In the very mildest form the patient should 
remain in the house, and when the symptoms are 
only moderate, should keep in bed till some time 
after the eruption has disappeared. It is particu- 
larly necessary to avoid exposure to cold. The 
sick room should be kept at a uniform tempera- 
ture of 60° F. to 65° F. night and day, and ven- 
tilated once or twice a day, while a thin cloth 
is thrown over the head and face of the patient in 
bed. The sick room should have bare floors, no 
carpets, hangings or curtains ; wooden furniture, 
and, if such a room is available, one with white- 
washed, varnished, or painted walls. 

Diet. — Pure cold water is the best drink ; the 
juice of oranges, lemons, and acid drinks are 
often grateful. 

The stomach is inflamed as well as the skin ; 
hence there is deficient secretion of gastric juice, 
and the food should be given in small quantities 
and often, along with pepsin or pancreatine, with 
l-16th grain of morphia, if necessary to prevent 
purging. 



Scarlet Fever. 67 

Soups, stewed fruit, and milk and beef-tea are 
the best food, avoiding much seasoning. 

Convalescence. — Iron tonics should be given 
for some time, either as tincture of the perchlo- 
ride of iron — ten drops twice a day in water — or 
citrate of iron and quinine — two grains twice a 
day. In those of delicate digestion, lactate of 
iron or the saccharine carbonate can be given. 
In all the preparations, the dose to be taken after 
breakfast and dinner, and continued for some 
time, average three weeks. 

Preventive. — When the skin begins to peel it 
should be rubbed all over with carbolic oil — one 
part carbolic acid to forty parts of olive oil — and 
when the peeling has ceased the oil should be 
washed off in a warm bath, with a tablespoonful 
of carbolic acid to every gallon and a half of 
water. 

^ The reason for this is that the small scales of 
skin carry infection, and flying about in the air 
they are inhaled or get caught in the dress, where 
they may be carried to a distance, and getting 
loose be inhaled there, causing a fresh attack of 
fever. The oil clogs the scales and prevents them 
flying, while the carbolic acid destroys their in- 
fecting power. The oil may be washed off daily 
in a warm carbolic acid bath; the skin wiped 
dry and re-oiled ; one tablespoonful should cover 
the whole body except the hair. 

During the illness a sheet should be fixed hang- 



68 Dr. J. Keari's Lectures. 

ing down outside the door and moistened from 
time to time with dilute permanganate of potash 
solution, one to forty, or carbolic acid one to 160 of 
water. 

After convalescence all woolen articles, books, 
etc., should be baked for two hours at 250° F. 
Iron and wooden articles scalded and washed 
with soap and water, or carbolic acid and water 
one to forty. 

Soiled linen should at once be plunged in a 
tub of carbolic acid and water one to forty, or per- 
manganate of potash aod water one to forty, and 
afterwards boiled for a little time before washing. 

The room should be disinfected by either chlo- 
rine or sulphurous acid. 

CEREBROSPINAL FEVER. 
(Inflammation of Spine and Brain.) 
This is likewise eruptive, and generally never 
occurs the second time with same person; is 
very like typhus fever. It begins suddenly 
with shivering, sickness, intense headache, 
pains in the neck, trunk and limbs. The fever 
increases; breathing is quick; the patient is 
restless and has a look of distress ; the tongue is 
dry, and there may be obstinate vomiting ; when 
there is an eruption it is lighter in color, appears 
sooner and fades more speedily than typhus, and 
is succeeded by peeling of the skin. The sensi- 
bility of the surface is great, every- touch causing 



Cerebro- Spinal Fever. 69 

agony. The symptoms increase up to the third 
day, when swallowing and breathing become af- 
fected; the head is dragged back on the neck 
[see Fig. 4], delirium, stupor, and death occur 
from the fifth to the eighth day. The disease 
may continue three or four weeks and convales- 
cence as niany months. The fever frequently 
lasts for a very short time, but is generally fatal 
from the 5th to the 8th day. 

TREATMENT. 

Take 

Tincture aconite root 24 drops. 

Water 2 oz. 

Mix. 

Dose — Teaspoonful every hour in water, until 
pulsations are reduced, during which time employ 
dry cupping to the back of the neck, and sponge 
with cold water. 

When the pulse is reduced to about eighty-five, 
discontinue • the above treatment and administer 
the following : 

Take 

Bromide potash 1 oz. 

Water. . . ". 1 pint. 

Mix. 

Dose — Tablespoonful eveiy three hours. 
If the nose is involved there is a yellow foetid 
discharge. 

When the windpipe is affected there are hoarse- 
ness, loss of voice, and difficulty of breathing. 




Fig. 4— Oerebro- Spinal Fever. 



Ccrebvo- Spinal Fever. 71 

Dangerous Symptoms. — A quick, feeble, or 
very slow pulse, difficult breathing, delirium, per- 
sistent vomiting. The total duration is about 
three to fourteen days. 

After-Effects. — About two to four weeks 
after, but never immediately, paralysis is apt to 
set in, most commonly of the palate, causing 
nasal voice, and fluids enter the nose at the pos- 
terior naries (back of the throat), causing diffi- 
culty in swallowing, and of the eye, causing 
strabismus (squinting), or of the heart, causing 
death by asphyxia (fainting). 

Nourishing diet, frequently given in small 
quantities. Inhalation of steam containing vin- 
egar, three ounces of vinegar to one pint of water. 
Where the windpipe is carry affected, tracheotomy, 
(opening respiratory passage). 

Convalescence. — Sea air and bathing, nourish- 
ing diet, quinine and iron tonics. 

RUBEOLA. 

(German Measles.) 
Is an affection midway between scarlet fever 
and measles in its symptoms, and by many sup- 
posed to be a combination of the two, but is prob- 
ably a distinct disease. One attack of rubeola 
gives protection from another, but not from scar- 
let fever or measles; it is eruptive, there is little 
or no fever, and little tendency to inflammation 
of the lungs or kidneys. 



72 Dr. J. Kean's Lectures. 

About two or three weeks after exposure to in- 
fection the disease appears, with running at the 
nose, watering of the eyes, sore throat, headache, 
and slight fever (100° F.) ; on the third or fourth 
day the eruption appears on the head and 
face, and spreads to the trunk and limbs, some- 
times disappearing on the face before it appears 
on the limbs. The eruption consists of spots like 
measles, but much brighter red and ' more clus- 
tered together. The eruption fades about the 
tenth day, and is succeeded by peeling off of the 
skin in scales. 

Treatment. — Same as in measles. Confine- 
ment to a warm room, milk diet. 

TYPHUS FEVER. 

(Camp or Ship Fever.) 
This is not apt to recur to same person; is 
attended with eruption ; about two to twelve days 
after exposure to infection the fever begins sud- 
denly with chills, hot skin, cold sweat, pain in 
back, severe headache, which ceases about the 
tenth day, quick pulse, over 100, and fever. Sleep 
is disturbed and unrefreshing, and when not 
asleep there is a constant tendency to drowsiness. 
The tongue is large and coated with white, there 
is great thirst, and the bowels are constipated. 
The face is flushed and dusky, the eyes water, the 
expression is dull, heavy and stupid, the mind 
ceases to think, and attention cannot be fixed ; the 



Typhus Fever. 73 

patient lies with eyes open, but sees nothing, and 
takes no notice of what goes on around (see Fig. 5). 
There is much restlessness and great muscular pros- 
tration, the weakness soon becoming extreme, so 
that the patient slips down in the bed. The char- 
acteristic eruption, which does not disappear on 
pressure, comes out from the fifth to the seventh 
day, and consists of one crop ouly, which re- 
mains out from seven to ten days. It appears as 
dusky red or mulberry-colored spots of the size 
of millet seeds, and a second lighter-colored rash 
that seems to be imder the skin, the two together 
giving a mottled appearance. The rash appears 
first on the back of the wrists and borders of the 
armpits, and spreads to the trunk and lower 
limbs. Towards the end of the first week the 
headache ceases and violent delirium commences, 
followed by collapse or low muttering delirium ; 
the prostration increases and is greatest towards 
morning. The pulse is 100 to 130. 

The breath becomes icetid, the skin cooler, and 
the eruption darker, till on the eighth or tenth 
day there are blood stains under the skin. The 
teeth and lips are covered with a crust, the 
tongue hard, dry and converted into a ball. The 
temperature rises till the fifth day when it may 
be 103° F. to 107° F., the morning temperature 
being always lower than the evening. Muscu- 
lar weakness is extreme, and the patient pays no 
attention to external objects, but the mind is 




Fig. 5.— Typhus Fever. 



Typhus Fever. 75 

active as in a dream, and there may be great 
mental suffering. About the fourteenth day usu- 
ally amendment sets in, and the patient has a 
quiet natural sleep, from which she awakes ration- 
al but confused. Improvement or death (when 
the eruption continues visible on the body) gen- 
erally takes place between the twelfth and seven- 
teenth days. After the first week there is a pe- 
culiar odor. 

During convalescence the hair and scales of the 
skin are shed. 

Treatment. — This being a very complicated 
disease, requires tJie most skillful treatment ; there- 
fore, slwuld you lack full confidence in your compe- 
tency with tlie aid of the following directions, con- 
sult a ' physician of reputed skill. 

Take 

Tincture aconite root 15 drops. 

Water 2 oz. 

Mix. 

Dose — One teaspoonful every hour ; with every 
second dose combine diaphoretic powder, 10 gr. 

Continue for ten hours ; next after this alternate 
turpentine emulsion with diaphoretic powder 
every hour for a further ten hours, and discon- 
tinue aconite. Then substitute for all afore- 
named remedies, fluid extract veratrum veride, 
in 1 drop doses every hour in half wineglass of 
water. After catarrhal symptoms have disap- 
peared, discontinue the latter, and — 



76 Dr. J. Kea/ris Lectures. 

Take 

Chlorate of potash % oz. 

Water J£ pint. 

Mix. 

Dose — One teaspoon ful every two or three hours, 
and give a stimulating bath of the following : 
Take 

Sulphite of Soda 1 oz. 

Alcohol 2 oz. 

Water 1 pint. 

Mix. 

Followed by a mild cathartic. If this treat- 
ment is accurately followed a care will be effected 
in six to seven days. I would further recommend 
in this connection cold sponging and cold bath, 
free ventilation ; % a grain of quinine with 10 
drops of sulphuric acid twice a day, and above 
all the careful and discriminating use of stimu- 
lants, including alcohol, tea, coffee and extract of 
beef, especially towards morning. There is no 
disease which requires more careful and con- 
tinued watching. Alcohol should not be given if 
there be severe darting headache, noisy active 
delirium, or strong pulse, or if delirium is in- 
creased by its use. But if there is a soft slow 
pulse, cold extremities, dry brown tongue, or low 
muttering delirium, and if under its use the tongue , 
becomes moist and restlessness gives place to 
sleep, it* does good. The dose may be two tea- 
spoonfuls of whiskey or brandy, with the same 
amount of hot milk, every hour, along with small 
quantities of nourishing stimulating food, as 
beef-tea, milk, tea, or coffee. 



'Typhoid Fever. 77 

TYPHOID FEVER. 
(Gastric Fever, Infantile Remittent.) 

Protects from second attack, and is accom- 
panied with eruption. The whole duration of 
this fever is usually about twenty-three days, but 
it varies considerably. About two weeks after 
exposure to the infection the fever begins gradu- 
ally by an indefinite feeling of illness, depression, 
dullness, restless sleep disturbed by dreams, sing- 
ing in the ears, headache, dizziness, and occasion- 
ally bleeding from the nose. With the onset of 
the fever there are chills, shiverings, and pains in 
the limbs, the pupils are dilated, and towards 
evening the face is flushed, with pink cheeks ; the 
abdomen is swollen and tender, and on pressure 
near the right hip gives a gurgling sound. 

First Week. — The tongue is at first broad, 
moist, and coated with white, which falls off, 
leaving bright red stripes down the sides or mid- 
dle. The pulse is 90 to 100. The patient already 
feels weak, and lies on his back gazing fixedly 
and showing no interest in what goes on around 
him, but on being .spoken to, after a moment's 
characteristic pause he answers quite readily. 
There is great thirst, no appetite, and a slimy or 
bitter taste in the mouth. The bowels are usually 
constipated, but sometimes there is diarrhoea. If 
there is delirium it is generally active, the patient 
wishing to leave his bed, and living in an excited 
dream. The temperature is very characteristic 



78 Dr. J. Kean's Lectures. 

till the height of the fever is reached, being two 
degrees Fahrenheit higher in the evening than in 
the morning, and one degree lower next morning 
than the previous evening. 

Second Week. — The pains in the head and 
limbs cease, dizziness and weakness increase, at- 
tended at different periods by deafness. The 
lungs are more or less affected with bronchitis, 
and confusion of intellect becomes so great that 
the patient will not help himself to water which 
is standing beside him, though when put to his 
lips he drinks greedily. The tongue becomes 
dry and brown, and the teeth are crusted, causing 
a repulsive odor. At the beginning of the second 
week diarrhoea usually presents itself, the stools 
being of the color and consistence of thin mortar. 

Eruption. — From the seventh to the fourteenth 
day the eruption appears on the abdomen, chest 
and back, in successive crops of a few pale rose- 
colored pimples, which disappear on pressure 
but return when the finger is removed ; each pim- 
ple is of the shape of half a pea, and about the 
size of a millet seed. Each crop of pimples lasts 
three days, and several crops in successive stages 
are out together, the whole amounting to hundreds. 

Third Week. — The weakness continues to in- 
crease, delirium becomes low and muttering, 
with picking at the bedclothes and twitching of 
the muscles. Diarrhoea increases, from three to 
twenty stools in twenty-four hours. As the patient 



Typhoid Fever. 79 

loses strength, the stools are passed involuntarily 
in bed. The bladder is apt to be injured by 
over-distension from not passing water, and should 
be attended to daily. Bed-sores are very apt to 
form on the back and buttocks. In fatal cases 
death is generally towards the end of the third 
week. In favorable cases about the middle of 
the third week the symptoms abate, the stupor 
gives place to natural sleep, and he begins to re- 
cognize his attendants, the face becomes paler 
and not so blue looking ; the cough is stronger, 
and he is able to expectorate, and the tongue 
grows moist at the edges and tip. 

Fourth Week. — There is slow convalescence, 
with some confusion of intellect, which may last 
for months. 

AFTER-EFFECTS. 
The bowels are practically always more or less 
ulcerated (ulcers in Peyer's patches). An ulcer 
may open into a blood-vessel any time after the 
first week, and may cause fatal hemorrhage, or 
the bowel may burst where it is weakened by an 
ulcer, which is more likely to happen when it is 
over-distended with food or wind, or in conse- 
quence of a fall or blow, and finally an ulcer may 
perforate through the bowel without any violence. 
Inflammation of the lungs may occur during the 
course of the fever, and prove fatal. Typhoid 
fever is very apt to start consumption in those 



80 Dr. J. Keari's Lectures. 

predisposed to it. During the fever the body be- 
comes very emaciated, losing ten to twenty lbs. 
weight. The progressive rise of temperature in 
typhoid fever is very marked, and gives valuable 
information. 

Some cases of typhoid fever are so mild that 
the patient pays no attention to it, or may never 
discover it till some of its evil after-effects present 
themselves, such as perforation of the bowel, pass- 
ing blood, or rupture of the bowel when straining, 
any of which may cause sudden death. 

Treatment — Is directed to reduce the temper- 
ature, to restrain but not to stop the diarrhoea, and 
to keep up the strength ; sponging the surface of 
the body with tepid or cold water is of use. In 
severe cases the cold bath cautiously used for 10 
to 15 or 20 minutes, the temperature at first being 
98° F. and cooled down by cold water to 60° F. 
It may require to be repeated four times in 24 
hours. During cold stage : 
Take 

Solid extract of belladonna % oz. 

Muriate of ammonia 1 oz. 

Boiling water 1 pint. 

Mix. 

And apply over abdomen, also hot mustard cloths 
over extremities, and warm drinks, ginger tea etc. 

Inflammation — (Hot Stage). 
Take 

Tincture of aconite 30 drops. 

Water 2 oz. 

Mix. 



Typhoid Fever. 81 

Dose — One teaspoonf ul eveiy one or two hours, 
and apply the following: 

Take 

Spirits turpentine % oz. 

Olive oil 2 oz. 

Mix. 

Take also turpentine emulsion, 2 to 5 drops 
every hour. (See precautionary rules, Lecture 
XVII.) 

To restrain the diarrh'ea, lime water and boiled 
milk, equal parts of each, cooled with ice, are 
food, drink, and medicine. If the diarrhoea is 
severe, a tablespoonful of chalk mixture and six 
drops of laudanum; and if this fails, an injection 
of two tablespoonfuls of starch mucilage (starch 
and boiling water) and 15 drops of laudanum may 
be given twice a day. 

Repeat the above treatment in three days if 
necessary. 

To restrain bleeding: Turpentine, 20 drops in 
honey or yolk of egg given every hour along with 
4 grains of gallic acid. If perforation or rupture 
occurs, the abdomen suddenly swells and becomes 
very tender, the patient is pale, faint, and col- 
lapsed, and generally dies within three days. 
Give two grains of opium at once, and repeat it 
every two hours till six grains are given. Discon- 
tinue all food and drink except taking ice for live 
days or longer, during which time the patient 
must be fed by nourishing injections of beef-tea 
and yolk of egg not to exceed two tablespoonfuls 



82 Dr. J. Kearts Lectures. 

at a time. Apply cold-water cloths to the abdo- 
men, and renew them every quarter of an hour 
for the first day and every half hour for the second 
day. 

After the first eight clays half a grain of qui- 
nine with ten drops of sulphuric acid twice a day ; 
if the stomach will not bear this two grains of 
iodide of potassium and ten grains of bicarbonate 
of potash twice a day. If there is much heat 
and tenderness of the abdomen, cold-water cloths 
should be applied three times a day. 

Food. — Should be chiefly milk, warm, if pos- 
sible, from the cow, with beef-tea, soups, and beat- 
up eggs. It should be given often in small quan- 
tities, in very severe cases every hour day and 
night. No solid food should be given till at least 
seven days after convalescence has begun. 

Nursing — Is of the utmost importance. Food 
and drink should be given at regular intervals 
unasked by the patient, and when there is a crust 
on the teeth and lips the mouth should be fre- 
quently wiped with a soft wet cloth, for which even 
delirious patients show relief and gratitude. 
Constant close attention is needed to the cleanli- 
ness of the person and linen, otherwise bed-sores 
are sure to form and be both troublesome and 
dangerous; threatening bed-sores should be 
painted with white of egg beat up with spirits of 
wine, and an air or water cushion used to relieve 
the pressure. The bladder should be emptied at 



Typhoid Fever. 83 

least twice a day by the nurse. A teaspoonful of 
carbolic acid with a little water should be put 
into the bed pan each time before use, and the 
stools should be buried away from running water 
or wells, or well mixed with three tablespoonfuls 
of carbolic acid before pouring into a drain; 
soiled linen should at once be placed into a tub 
of carbolic acid and water — 4 tablespoonfuls of 
acid to each gallon of water — and afterwards 
boiled and washed. 

Convalescence — Is slow and tedious. The 
patient is often ravenous, but should get no solid 
food until seven days after the fever has disap- 
peared, and not much at a time ; the least indis- 
cretion in diet may set up inflammation in the 
ulcerated bowel, and may cause a relapse, ending 
in perforation and death. Generally there is some 
confusion of intellect left for an indefinite time 
afterwards. 

Preventive Treatment during Epidemics. — 
Sewer gases rising up into houses, bad drinking 
water and milk are the usual sources of infection. 
We should see that all drain pipes rising into the 
house are properly trapped and ventilated, but not 
into the house, as often happens, and above all 
that the escape pipe of the drinking-water cistern 
does not ventilate the sewer into tKe cistern 
chamber. All water used for drinking, cooking, 
and washing dishes should be boiled. All the 
milk used should also be boiled. Wells into 



84 Dr. J. Kearts Lectures. 

which the surface water descends should not be 
used for domestic purposes. Horses (and perhaps 
other animals) are also subject to typhoid fever, 
and in some otherwise inexplicable cases it seems 
probable that they may have conveyed the infec- 
tion, the horse droppings having been soaked by 
rain into surface wells. 

DENGUE. 
(Break-bone Fever.) 

This disease, unlike the eight preceding, is 
liable to attack the same person a number of 
times. 

It occurs chiefly in South America and the 
West Indies. 

It attacks very suddenly with fever, weariness, 
pain in the head and back, and excruciating pain 
in the joints, which are swollen. In forty-eight 
hours the symptoms subside, but return to a less 
degree on the fourth day. On the fifth or sixth 
day an eruption appears on the whole body, 
beginning on the head and face and most marked 
on the palms of the hands and soles of the feet. 
The color is intermediate between scarlet fever 
and measles, or like slight erysipelas. The glands 
at the back of the head and neck (occipital) are 
swollen. On the seventh or eighth day the skin 
begins to peel and the acute stage is over, but 
severe pains in the limbs may continue for a long 



Erysipelas. 85 

time. The symptoms increase and subside sev- 
eral times a day. It is very rarely fatal. 

TREATMENT. 

fTake 

Sulphate of quinine 10 grains. 

Powdered capsicum 3 grains. 

Powdered leptandrin 3 grains. 

Mix. 

Make three powders. Dose — One every two 
hours, at the commencement, followed by opiates 
to- relieve the pain, such as two grains of opium 
every four or six hours, if required. 

Convalescence. — Tincture of iron, ten drops 
thrice a day. 

ST. ANTHONY'S FIRE. 

(Erysipelas.) 
About seven to fourteen days after exposure to 
infection the fever appears with chilis, shiverings, 
sore throat. The tongue is coated with white and 
there is a bitter taste in the mouth, with thirst, 
loss of appetite, sickness and vomiting, but often 
there are no symptoms till the skin is affected. 
The affected skin feels hot, tense, and painful, 
followed by redness and swelling. The nearest 
glands are swollen and tender. The redness is at 
first clear and speckled, but soon becomes dark 
and diffuse. The skin feels stiff and brawny to 
the fingers, like thick leather, and the scarf skin 
generally rises into small blisters. About the 
third or fourth day the redness begins to fade, 
the swelling subsides, the pain abates, and the 



86 Dr. J. Kean y s Lectures. 

blisters dry up, and the scarf skin peels off in 
large flakes, even when there have been no 
blisters. When the scalp has been attacked the 
hair falls off, but soon begins to grow again. 

During the spreading of the inflammation the 
temperature rapidly rises to 105° P. or more, the 
pulse is 100 to 120, and there is often delirium. 

The inflammation may be subsiding at one 
point while it is at its height or even spreading at 
another. The spreading may either be by ex- 
tension from a part of the original portion ot 
skin, or it may leave one place and appear at 
another some distance off. This wandering 
(erratic) erysipelas is generally very mild in its 
course, but it may last a long time; weeks or 
even months. 

Erysipelas has been divided into many varie- 
ties, but the following are sufficient : 

Idiopathic. — When it appears on an unbroken 
sound skin, generally on the head or face. 

Traumatic. — When it attacks a wound ; it is 
very apt to occur when the scalp is wounded, or in 
crowded hospitals with any wound however small. 

Simple — Erratic ; stationary. When the inflam- 
mation is superficial and confined to the skin 
(slight attacks). 

Phlegmonous. — When the deep layers of the 
skm and tissues under are involved (severe at- 
tacks), abscesses generally form under the skin, 
and the pus should be let out by incisions. 



Erysipelas. 87 

Erysipelas differs from the eruptive fevers in 
one attack not protecting from but predisposing to 
another. At all ages it is a dangerous and deceit- 
ful disease; when it exists with Diabetes or 
Bright's Disease, it is almost always fatal. 

It is distinctly infectious, but we cannot 
always trace the infection to a human being ; pos- 
sibly some of the lower animals may be subject 
to it, and so carry the infectious germs. 

Predisposing Causes. — Wounds of the scalp ; 
exposure to cold and wet; intemperance; previ- 
ous attacks; old age; weakness; constitutional 
peculiarity. 

When death occurs it is in one of three ways. 

1. By stupor (coma). The inflammation spread- 
ing from the scalp through the skull to the mem- 
branes of the brain. 

2. By exhaustion. 

3. By suffocation, the inflammation closing 
the air passages. 

General Treatment. — Rest, protection from 
cold, and a mild purge, and tincture of iron, 20 
drops in water every three hours. Always wash 
the mouth after taking tincture of iron or any 
acid, otherwise the teeth will be corroded. Good 
nourishing food, and where it is required (see 
general treatment of fevers) port wine or brandy. 

Local Treatment. — In slight cases paint over 
the surface with flexible collodion. Where there 
are blisters, dust over the surface with baked 



88 Dr. J. KearVs Lectures. 

flour, and cover it with a thick sheet of cotton 
wool. 

In phlegmonous erysipelas, whenever pus can 
be felt under the skin, let it out by free incisions. 




Fig. 6 — Cynanchb Parotid^ea.— (Mumps.) 
CYNANCHE PAROTIDJEA.— (Mumps.) 

I come now to mumps, a non-eruptive disease. 
It is infectious and most prevalent in cold, damp 
weather. It attacks both sexes before puberty, 
but boys most frequently, and one attack protects 
from another. 

There are usually slight fever, headache, and loss 



Mumps. 89 

of appetite for two or three days, when the gland 
below the ear on one side, rarely on both at first, 
begins to sweil, and the skin over it becomes 
pale or slightly reddened. About the sixth day 
the fever ceases, and in eight or ten days the face 
appears natural again ; occasionally abscess forms 
in the gland. In girls the breasts, and in boys the 
testicles, are often swollen and painful. 

Treatment. — A gentle purge of sulphate of 
magnesia (Epsom salts), usually two drachms. 
Rest. Fomen cation of the painful part. Farina- 
ceous diet. 

PERTUSSIS. 

(Whoopesg Cough.) 
Once suffered shields the same patient from 
second attack, is not eruptive, yet is infectious. 
Five or six days after exposure to infection the 
disease begins like a common cold with fe^erish- 
ness, sneezing, cough, and intolerance of light. 
In about ten days the fever abates, but the cough 
increases and assumes its peculiar sound or 
whoop. The coughing fit begins with a long- 
drawn clear piping sound, followed by a series of 
short rapidly interrupted expiratory coughs, and 
succeeded by a long-drawn crowing inspiration 
which is the whoop, and which alternates with 
the cough until after recurring several times, 
when the fit terminates by a quantity of glairy 
tenacious mucus like white of egg being brought 



90 Dr. J. Kean's Lectures. 

up, or there is vomiting. During the fit the face 
becomes almost black, the eyes water and appear 
to be bursting from their sockets, the child seems 
on the point of suffocation ; but soon after it is 
over the child returns to its play, or if it has vom- 
ited, it eats quite readily. A sensation of tickling 
in the throat precedes each attack, which the 
child recognizes with dread and clings to its 
nurse, seeks a support for its head, or begins to 
cry. There may be two or three fits in a day or 
up to twenty-four or even more. 

The disease lasts from three weeks to three 
months, and when not properly cared for, it may 
last for a year or longer. The whoop and cough 
may recur after it has appeared cured for some 
time, by errors in diet, exposure to cold, etc. 
Whooping cough may be complicated with 
emphysema, pneumonia, bronchitis, or convul- 
sions, water on the brain, congestion or diarrhoea, 
all of which are apt to lead to fatal results. 

Treatment. — An even emperature day and 
night in a room at 68° F. If the child is old 
enough to understand, it should be made to re- 
press the cough as much as possible. If the 
cough is severe, 
Take 

Solid extract of belladonna 3 grains. 

Bicarbonate of soda 15 grains. 

Syrup of orange peel 3 oz. 

Mix. 



Whooping Cough. 91 

Dose — One teaspoonful thrice daily. 

If there is much vomiting, 

Take 

Cochineal 15 grains. 

Bicarbonate of soda 15 grains. 

Crystal drips 3 oz. 

y Mix. 

Dose — One teaspoonful, just before each fit. 

(See precautionary rules, Lecture XVII.) 

Change of air has often a very good effect. 

The food should be bland and nutritious — milk, 
stewed fruit, tapioca, etc. 

Convalescence. — Iron tonics and nourishing 
diet should be given. Any indiscretion, as' ex- 
posure to cold, errors in diet, or even strong 
mental emotion, may reestablish the cough and 
whoop, even when it has disappeared for some 
weeks. 

Children supposed cured may have a relapse of 
the cough on going a voyage. 

YELLOW FEVER. 
(Black Vomit.) 

Is an infectious continued non-eruptive fever, 
occurring, as a rule, only once during life. The 
germ of yellow fever is an exotic in the United 
States, and does not grow when the tempera- 
ture is below 72° F. It usually prevails in the 
low-lying districts on the sea coast of Central 
America and the West Indies, but it has several 
times been imported into the United States, 
where it has run its course and proved fatal. The 



92 Dr. J. Keaii's Lectures. 

alarming and rapid spread of this dread disease, 
during the summer of 1878, in some of the 
Southern States, was of such unparalleled magni- 
tude as to require the attention of Congress, 
whose labors on this subject will now doubtless 
be directed to the better establishment and main- 
tenance of quarantine regulations of the most 
rigorous character at all the ports of entry along 
our entire coast. 

While it is not yet definitely known that the 
yellow fever epidemic of 1878 was brought to 
our shores from a foreign port, the result ot 
patient investigation, made pursuant to direc- 
tions of the Government, has left but little doubt 
that the first case was smuggled from abroad. 

Be this as it may, the existence of but one case 
only, either from spontaneous origin or introduc- 
tion by ships, could as well have entailed tenfold 
greater destruction of life than was witnessed, so 
swiftly contagious is this disease in a climate 
the least favorable to its development. 

The long protracted heat, together with the 
noxious effluvium rising from vast deposits of de- 
composed vegetable matter, combined to extend 
the last visitation of that disease far beyond the 
limits to which it had reached in recent years ; 
and so on, without the best known and even 
experimental precautions, it might, from year to 
year, widen its appalling ravages to the full ex- 
tent of its geographical limits. 



Yellow Fever. 93 

The pathology and origin of this fever not 
being well settled, it is difficult to prescribe infal- 
lible remedies, hence physicians are left to apply 
their skill and energies to preventive measures. 

The symptoms vary considerably according to 
the epidemic, the fever presenting several types. 

1. Algid. — The patient while in the enjoyment 
of his usual health feels suddenly as if struck by 
a heavy blow on the back, and falls down and 
dies in a few hours. The surface is cold, the 
countenance sunken, the eyes dull and filmy, the 
pulse small, feeble, and quick, and the patient 
feels cold, depressed and wretched. 

2. Sthenic. — Chiefly in strong people in the 
prime of life. There is severe headache and pain 
in the back, high, full, hard pulse, flushed face, 
and high temperature. 

3. Hcemorrhagic. — There is heat, pain, and 
tenderness below the breast-bone, and a tendency 
to profuse bleeding, never from one source or organ 
only. 

4. Purpuric, — There is intense yellow skin 
and eyes, with large dark patches of effused 
blood-coloring matter under the skin. 

5. Typhous. — There is great prostration of 
strength and low muttering delirium. 

There may be premonitory symptoms of loss 
of appetite, costiveness, flatulence, bright moist 
eyes and debility. Two to ten days after exposure 
to infection the disease begins with chills and 




Fig. 7.— Yellow Fever. 



Yellow Fever. 95 

flushes of heat, which soon become steady fever, 
higher in proportion to the severity of the pre- 
vious chills. There is severe headache and pain 
in the back, flushed face and suffused e}~es, 
which become red and ferrety. The pulse is 90 
to 120. The skin feels hot and dry, giving a ting- 
ling feeling of heat to the hand, or may be per- 
spiring, dark-colored, flabby, and even cold. It 
is usually lemon*colored or greenish yellow. The 
tongue is creamy white, with crimson tip and 
edges. From the commencement, or a little 
later, there is sickness and tenderness over the 
stomach, with vomiting, at first of a clear glairy 
fluid, but soon becoming dark like coffee 
grounds. 

The patient craves cold drinks, which are im- 
mediately vomited, at first with some pain, but 
subsequently without effort. 

The urine is scanty and high-colored and 
albuminous. 

The stools are deficient in bile and become 
black from blood. The mind is disturbed and 
more or less delirious, the patient becoming rest- 
less and vigilant, and disposed to leave his bed 
[see Fig. 7], if permitted, and having wild hallu- 
cinations like delirium tremens. The breathing 
is oppressed, and often towards the close there is 
hiccough and wild shrieking, or melancholy 
Availing. Should the symptoms become alleviat- 
ed, the pulse becomes slower, delirium subsides, 



96 Br. J. Kean's Lectures. 

and, above all, the irritability of the stomach 
ceases ; active perspiring, bleeding from the nose, 
or discharge of bile from the bowels may take 
place on the way to recovery. If the ferrety eyes 
whiten, the lips and cheeks become pale, but the 
delirium and irritable stomach persist, the appar- 
ent remission is delusive, and a fatal result 
threatens. 

When the black vomit is plentiful and the 
urine abundant, the intellect remains clear and 
unclouded. 

Favorable Signs. — Pulse between 100 and 110, 
even and regular; urine in good quantity, no 
matter how dark; black vomit and tenderness 
over stomach lessened or gone ; bile green or yel- 
low in stools or vomit. 

Unfavorable Signs. — Fiery crimson tip and 
edges of tongue; very irritable stomach, and 
very severe headache; a streak of blood in the 
early vomit. Beginning with a fit of convulsions, 
black watery stools with shreds, torpid, statue- 
like face, scanty urine, copious black vomit, fal- 
tering speech and difficulty in putting out the 
tongue, ghastly appearance, and faint nauseous 
odor. 

TREATMENT. 

Take 



Tincture of aconite root 15 < 

Fluid extract of veratrum viride ... 15 drops. 

Water 2 oz. 

Mix. 



Yellow Fever. 97 

Dose — One teaspoonful every hour for four or 
five hours, followed by an alcoholic vapor bath. 

Now our best and most reliable remedy is gel- 
semium, which should be given in large doses, 
viz: 3 to 6 drops in water every hour until 
double vision and sleep are produced. (See pre- 
cautionary rules, Lecture XVII.) 

Frequent copious injections of salt and water, 
one pint of water and a tablespoonful of salt, 
gum water or arrowroot, four drops of chloroform 
before food to allow the stomach to retain it. 
Free ventilation. No opium when there is sup- 
pression or scanty urine ; about the fourth day 
frequent small doses of camphor or capsicum 
and nitrate of potash (saltpetre). A wet compress, 
four folds of cotton or linen wrung out of cold 
water and placed over the stomach, sometimes 
subdues the vomiting. The crisis usually occurs 
on the fifth day, the total duration being three to 
nine days. The infection is chiefly from the 
vomit, and the fever is very fatal, one in three 
usually dying. Malarious yellow fever is not in- 
fectious, and comparatively seldom fatal; there 
are black vomit, black stools, and yellow skin 
and eyes, as in specific yellow fever. 



98 Dr. J. Kean's Lectures. 

PLAGUE. 

(Peste.) 

Is not eruptive, and but one attack occurs 
through life. 

Is believed to be a severe type of typhus fever, 
attended with swelling and suppuration of the 
glands, and spots of effused blood under the skin. 
The glands do not open till between the fifteenth 
and twenty-seventh day, when the fever has 
declined. It attacks chiefly the poor, weakly 
people, and women. Plague is always present in 
Egypt. 

Treatment. — Means of varied character have 
been employed to arrest this disease, but none 
have as yet become conspicuously distinguished. 
The most effective treatment, however, is in gen- 
eral that used in typhus gravior. 

DIPHTHERIA. 
(Putrid Sore Throat.) 

Is an ailment that affords no protection to a 
second attack; is non-eruptive and infectious. 

About thirty hours or less after exposure to 
infection the disease appears gradually like 
a common cold, with depressions, chilliness, 
loss of appetite; in severe cases shivering, 
sickness, and vomiting. There is slight dif- 
ficulty of swallowing, and the glands at the 
angles of the lower jaw (bifurcation of carotid) 
are swollen and tender. Inside the throat the 



Diphtheria. 99 , 

mucous membrane is red and swollen. A whit- 
ish grey patch forms on one of the tonsils, 
or some part of the back of the throat, and begins 
to spread till, either alone or joined to others, it 
covers the reddened surface and extends down 
out of sight. At first the greyish patch of false 
membrane is soft like cream, but presently 
becomes thick and tough and is of the color of 
dirty wash leather. When it comes off or is 
dislodged it leaves a loss of substance and a 
bleeding surface, covered soon by a new mem- 
brane which has a horribly offensive and putrid 
odor. 

There are generally three or even four false 
membranes in succession thrown off in bad cases 
and any wound or sore on the body also forms a 
membrane over it. 

If the membrane extends down the windpipe it 
may cause death by suffocation. There is a re- 
markable tendencyto paralysis throughout the dis- 
ease, and still more during convalescence. Death 
may occur from paralysis of the heart, from exhaus- 
tion, or suffocation, the mind remaining clear to 
the last except in suffocation. The total duration 
varies from forty-eight hours to fourteen days, but 
the after-effects may last for months. After con- 
valescence of some days or even weeks, paralysis 
of the heart may appear, causing death by faint- 
ing; but usually of the muscles of the palate, 
causing nasal voice, and fluids in drinking to run 



100 Dr. J. OCean's Lectures. 

into the nose; more rarely the limbs are para- 
lysed, or the muscles of the eye, causing squinting. 
Treatment. — Hot Stage : 

Take tincture of aconite, 2 drops every hour, 
and apply briskly to the throat the following : 

Take 

Spirits turpentine % oz. 

Olive oil 2 oz. 

Mix. 

During which time, and before development of 
membrane, use as gargle the following : 

Take 

Acetate of morphia % grain. 

Chlorate of potash % drachm. 

Water 4 oz. 

Mix. 

After the deposit is formed in the throat, apply 
with atomizer baptisia tinctoria, and give nourish- 
ing food in small quantities often repeated. 
Tincture of iron in five to ten drop doses may be 
taken in water four times in twenty-four hours. 
Moist warm air at 70° F. ; a kettle kept steaming 
into the room. 

Cojstvalescence. — Fresh air, good food, and 
bitter vegetable tonics, such as two tablespoonfuls 
of infusion of calumba twice a day, and light 
bitter beer. 

Diphtheria is very frequently associated with 
sewage emanations, and the cause will often be 
found in the drains or cesspools and imperfect 
ventilation. 



Relapsing Fever. 101 

RELAPSING FEVER 
(Recurrent Fever.) 

Is non-eruptive, infectious, and does not protect 
from second attack. 

About five days after exposure to infection the 
fever begins suddenly with chills and shiverings, 
followed by a persistent feeling of heat. There 
is pain in the forehead, weakness, dizziness, sing- 
ing in the ears, severe muscular pains in the neck 
and limbs. The face is flushed, the skin hot and 
dry. There is great thirst, a white tongue, loss of 
appetite, vomiting and jaundice. Delirium is 
rare, though the temperature is very high, and 
may reach 107° or 109° F. The pulse is 100 to 
150. 

About the seventh day, when the fever is at its 
height, a crisis occurs. There is profuse perspi- 
ration, sometimes bleeding from the nose ; all the 
symptoms cease, and the temperature falls in a 
few hours 9° F. or more— from 106° F. to 97° F. 
The pulse becomes very sIoav (45 to 50 per min- 
ute), and there is danger of death from fainting. 
After seven days, or the fourteenth day of the 
fever; all the symptoms recur, the second attack 
lasting three or four days, when there is a crisis 
as before, and the disease usually terminates ; but 
there may be a third, fourth, or even fifth relapse. 
The fever is very exhausting, and the patient may 
remain pale and sickly for months, with swelled 



102 Dr. J. Kean's Lectures. 

ankles, weakness, palpitation, noises in the ears, 
pains in the limbs, and dimness of vision. In 
severe attacks the hair may fall out, and the scarf 
skin peel off. 

It is impossible to say with certainty what fever 
it is till the relapse occurs. One attack does not 
protect from another, but it is rarely fatal, not 
more than five per cent, dying. Predisposing 
cause is famine and overcrowding. 

Treatment. — Rest. Iced milk and lime water ; 
tepid sponging; alcohol if required. Treat as 
other fevers. 

CHOLERA. 
(Cholera Morbus.) 

Is infectious, non-eruptive, and attacks same 
patient the second time. Is usually the result of 
some irritant in the food or drink, especially 
unripe fruit and sour wine or beer. 

The attack is generally abrupt, vomiting and 
purging begin and recur in rapid succession. 
Enormous quantities of fluid are evacuated, 
tinged green-brown or almost black by vitiated 
bile. There is severe pain in the stomach and 
bowels, and there may be cramps in the muscles 
of the limbs and abdomen. There may also be 
hiccough, difficult breathing, exhaustion, coldness 
of the extremities, with cool perspiration, and 
even fainting. Fortunately it is rarely fatal, the 
symptoms usually subsiding the succeeding day. 



Cholera. 103 

TREATMENT. 

Take 

Tincture of kino % oz - 

Bicarbonate of soda ^ oz. 

Tincture of opium 3€ oz - 

Essence of anise % oz. 

Crystal drips 3 oz. 

Mix. 

Dose — One teaspoonful every hour. When the 
stomach has disposed of its contents, apply a 
large hot poultice over the abdomen. (See precau- 
tionary rules, Lecture XVII.) 

ASIATIC CHOLERA. 
(Malignant Cholera.) 

This malady is infectious, non-eruptive, and 
does not protect from second attack. 

From thirty-six hours to three days after 
exposure to infection it commences by degrees. 

1st Stage. — There may be painless diarrhoea, 
which may last from a few hours to two days, 
with muscular trembling, weakness, and dizziness. 

2d Stage. — Vomiting and burning heat at the 
stomach, cold perspiration, dreadful cramps of all 
the muscles. The stools become copious, thin, 
colorless, odorless, like rice-water. There is 
unquenchable thirst; feeble, rapid pulse, hurried 
and difficult breathing, extreme restlessness, sup- 
pressed urine. The surface becomes blue, and 
the body seems to shrink visibly. The features 
become sharp, contracted, and corpse-like, the 
looks wild and pitiful. The eyes dim, sunken, 



104 Dr. J. Kean r s Lectures. 

with a dark circle round; the voice becomes a 
low and husky whisper. The skin is cold and 
wrinkled ; if a fold be pinched up it remains so 
for some time and then slowly disappears. The 
pulse ceases to be felt, the breath is cold, and the 
body has a corpse-like smell ; collapse, insensi- 
bility, and death follow. The first two stages 
may last from a few minutes to forty-eight hours 
each. 

3d Stage — Reaction. — If the patient survive 
eighteen hours he will likely recover; reaction, 
the pulse rises, the skin gets warm, and fever is 
set up which may pass into a typhoid form. 

Sometimes the attack is very sudden, without 
warning, death occurring in half an hour, or 
even in a few minutes. Like typhus fever, cholera 
is extremely fatal to drunkards. 

TREATMENT. 

Take 

Tincture of kino % oz. 

Bicarbonate of soda 3€ oz - 

Tincture of opium 32 oz. 

Essence of anise % oz. 

Syrup of orange peel 3 oz. 

rMix. 

Dose — One teaspoon ful every hour. 
As soon as the pulse flags brandy in iced 
water and cold compresses over the abdomen. 
The first part of an epidemic is generally much 
more fatal than the last. In one epidemic in the 
Southern States no deaths occurred after camphor 



Influenza. 105 

began to be administered on the third day of the 
epidemic. In another, nine out of every ten 
attacked at the beginning of the epidemic died, 
while toward the end of the epidemic three 
recovered out of every four attacked. 

It is of great importance to treat every appa- 
rently trifling diarrhoea at once by rest, lying 
down ; a warm poultice to the abdomen, and the 
cholera prescription. If diarrhoea is neglected it 
may develop in a few hours into an attack of 
malignant cholera. The stools should be mixed 
with a tablespoonful of carbolic acid and buried 
away from wells or running water, if possible, 
but in towns well mixed with crude carbolic acid 
and put into the water closet. 

INFLUENZA. 

(Epidemic Catarrh.) 

Is non-eruptive and affords no protection to 
second attack. From one day to two weeks after 
exposure to infection the disease appears with 
some one or all of the following symptoms : 

Chest. — Those of a common cold. Chills, 
shivering, pain in the forehead, watering of the 
eyes, running of the nose, sneezing, hoarseness, 
cough, sore throat, and yellowish expectoration. 

Head. — Fever — less in the morning than at 
night — gnawing pain in the bones, pain in the 
back and limbs, increased by touching, severe 
pain in the forehead, sleeplessness and delirium. 



106 Dr. J. K eari's Lectures. 

Abdomen. — White tongue, perverted taste (a 
bad or no taste), sickness, vomiting, diarrhoea. 

Great weakness, depression, and low spirits. 

The severity and the type of influenza epi- 
demics vary very much. One set of symptoms 
is prominent according to the epidemic; the 
most usual symptoms are those of a cold, which 
may be without fever, or more rarely fever with- 
out a cold ; but in all cases there is great weak- 
ness and depression. Mild cases end about the 
fourth day by a critical perspiration, that is a 
sudden profuse perspiration, after which the 
patient probably falls asleep, and all the symp- 
toms decline or disappear, when convalescence 
begins. In severe cases there is no subsidence of 
the symptoms till the eighth or tenth day. 

Influenza is apt to be fatal to the old or weakly 
or where there are affections of the heart or lungs. 

The fever is lower in the morning, and, where 
there is diarrhoea, is very like typhoid fever. 

I have seen an epidemic of influenza with 
typhoid fever, and in many cases it was impossi- 
ble to distinguish between them without the ther- 
mometrical test. 

The infectious germs of influenza are not eas- 
ily destroyed by the air, as many take the infec- 
tion without direct contact with the sick. One 
attack protects from another during the same 
epidemic. 



Influenza. 107 

Treatment. — Cold Stage : Treat as other fevers 
by use of hot applications. 

Hot Stage : Tincture of aconite, 2 drops every 
hour for a few hours, followed by fluid extract of 
veratrurn viride, 2 drops in water alternating 
every hour with diaphoretic powder. If inflam- 
mation does not subside give the turpentine 
emulsion to relieve the irritability of the throat and 
assist the kidneys, followed by 

Take 

Fluid extract of belladonna % drachm. 

Fluid extract of boneset. . 2 oz. 

Syrup of primus virginiana 1 oz. 

Mix. 

Dose — One teaspoouful every three hours, but 
reduce quantity if pupils dilate ; and in connec- 
tion every few hours take tincture of iron, 10 
drops, in water. (See precautionary rules, Lec- 
ture XVII.) 

Rest in a well-ventilated room at 60° to 65° F. 
If there is much cough, ipecacuanha wine in full 
doses. 

Easily digestible nourishing food given often ; 
if weakness is extreme, alcohol. 

Convalescence is often very slow, and requires 
nourishing diet. Quinine and iron tonics twice 
a day after food. 

PYJEMIA. 

(Surgical Fever.) 
This fever is non-eruptive yet infectious, and 
may attack the second time. Is a specific fever 



108 Dr. J. Keari>s Lectures. 

which is usually subsequent to suppurative in- 
flammation of an open wound, especially of the 
large joints, but it may also occur where there is 
no wound, as in chronic bronchitis with yellow 
purulent expectoration (bronchiectasis). It re- 
sults in the formation of several abscesses in the 
internal organs, joints or tissues. About three to 
five days after the injury the fever generally 
begins suddenly, with shivering and rise of tem- 
perature. The pulse is rapid, soft and small ; the 
countenance dusky yellow and anxious; the 
tongue becomes dry, and the breath has a sweet 
smell like new-mown hay. The patient is rest- 
less, sleepless, and in low spirits. Profuse per- 
spiration, with a heavy sickening odor, wandering 
pains like rheumatism, repeated chills and very 
high temperature, which rises and falls several 
times in the course of the day, mark the forma- 
tion of secondary abscesses. The disease is very 
fatal, the danger and rapidity of a fatal termina- 
tion being in proportion to the rapidity and 
severity of the shiverings. The pus in all the 
abscesses is infective, and if introduced into the 
circulation sets up pyaernia. The poison of 
pyaemia afFords an example of a germ which can 
be cultivated and its virulence increased. The 
original germ of pyaemia is probably harmless 
to people in good health, but having onee been 
cultivated into pyaemia is henceforth highly 
dangerous. 



Pycemia. 109 

TREATMENT. 

Take 

Sulphate of quinine 10 grains. 

Powdered capsicum 3 grains. 

Pulverized leptandrin 3 grains. 

Mix. 

Make three powders. t 

Dose — One powder every two hours, commenc- 
ing six hours before each expected chill ; also, 

Take 

Tincture of iron 15 drops. 

In half tumbler of water thrice daily; or, 

Take 

Dilute sulphuric acid in similar doses. 
Nourishing, food and free ventilation hasten 
recovery. 

SEPTICEMIA. 
(Hospital Fever.) 
Is a form of pyaemia when the fever is intense 
and the disturbance from blood-poisoning great, 
but there are no secondary abscesses, and it begins 
gradually with slight sickness and vomiting. It 
may result from wounds poisoned by decaying 
animal matter. 

Treatment. — Free exposure to fresh air. 
Nourishing digestible food, and stimulants at fre- 
quent regular intervals. 

Take 

Quinine , 10 grains. 

Powdered capsicum 3 grains. 

Powdered leptandrin 3 grains. 

Mix. 



110 Dr. J. Kearts Lectures. 

Make three powders. 

Dose — One every two hours. Repeat if neces- 
sary, commencing promptly upon discovery of 
the disease. 

When the fever is subdued, iron and sulphuric 
acid should be given thrice daily after food. 
When septicaemia occurs from a poisoned wound, 
up to the second day a hot bath half an hour as 
hot as can be comfortably borne, and large doses 
of alcohol, half a pint of brandy or whiskey per 
day, have given satisfactory results in the hands 
of the author. 

PUERPERAL FEYER. 

(Childbed Fever.) 

This disease does not protect from a second at- 
tack. Is a very fatal and contagious fever, allied 
to pyaemia. Like pyaemia, it may manufacture a 
poison from ordinary germs which becomes very 
contagious; but further, the infection germs of 
scarlet fever, erysipelas, and measles may give 
rise to it. From the third to the fifth day after con- 
finement, fever with chill may appear, followed 
by tenderness over the whole abdomen or only the 
lower half. The pulse rises to 120 or more, breath- 
ing becomes short and hurried, there is distress- 
ing thirst, and often sickness and vomiting. The 
flow of milk ceases, the discharges dry up, and 
there is swelling of the abdomen accompanied 
with diarrhoea. 



Puerperal Fever. Ill 

Treatment — Is of immediate necessity and 
should be given by persons experienced in giving 
medicine. 

Take 

Fluid extract of veratrum viride, 3 to 5 drops 
in water eveiy hour, oftener if necessary, then 
apply fomentation of hops sprinkled with turpen- 
tine to abdomen. Continue veratrum until pulse 
assumes its normal condition. (See precaution- 
ary rules, Lecture XVII.) 

It is extremely dangerous for a parturient 
woman to come in contact with the infection of 
scarlet fever, measles, and similar diseases. Puer- 
peral fever is also very contagious, and is easily 
carried by attendants and visitors though them- 
selves unaffected. 

PUERPERAL EPHEMERA. 

(Weed Fever.) 

Its chief importance is from its alarming re- 
semblance to the onset of pyaemia and true puer- 
peral fever. It occurs in low marshy districts, 
and may be due to the germs which cause ague. 

About the seventh day "after delivery there is 
fever with severe and long-continued chills ; there 
is great depression, the features are contracted, 
the eyeballs sink back in the sockets, the fingers 
are shrivelled and livid as in the cold stage of 
ague, the pulse is feeble but not much quicker. 
The discharges are arrested ; hysteria and delirium 



112 Dr. J. Kearts Lectures. 

are apt to occur. Profuse perspiration generally 
indicates a crisis, when the patient commences to 
recover — the discharges return, and the patient 
gets refreshing sleep. 

Treatment. — Warmth, hot drinks, hot bottles, 
and plenty of bedclothes, until the chilliness sub- 
sides. 

Take 

Sulphate of quinine 3 drachms. 

Powdered capsicum 1 drachm. 

Mix. 

Make sixty powders. 

Dose — One three times daily until they are all 
used, combined with nourishing food. 



LECTUEE III. 



Simple Continued Fever or Ague.— Remittent Fever. 
Intermittent Fever.— Hydrophobia. 



NOIST- INFECTIOUS SPECIFIC 
FEVERS. 

SIMPLE CONTINUED FEVER 

IS a joint name for several non-infectious fevers 
having no specific character, and lasting from 
twelve hours to ten days. 

Ephemera or Febricula is the name given to 
the shortest of these fevers where it lasts only 
from twelve to forty-eight hours. The fever arises 
with a frequent full pulse, white tongue, pains in 
the loins and limbs, constipation, scanty, high- 
colored urine, sometimes a slight eruption, soon 
going away. There is also flashed iace, severe 
headache, and occasionally delirium. There is 
generally copious perspiration as the fever sub- 
sides. 

Treatment. — Hot Stage : Tincture of aconite, 
2 drops in water every hour. 



114 Dr. J. Kearts Lectures. 

Take 

Sulphate of quinine 10 grains. 

Powdered capsicum 3 grains. 

Powdered leptandrin 3 grains. 

Mix. 

Make three powders. 

Dose — One every two hours beginning six hours 
before the expected chill. Followed by tincture 
of iron, 10 drops, largely diluted with water, three 
times a day; continue for two weeks. Cooling 
drinks and confinement to bed, etc. 

REMITTENT FEVER. 
(Malarious Yellow Fever.) 

Like ague, it is caused by malarious poison, 
but is found principally in the tropics. There is 
intense headache, and a sense of tightness across 
the forehead, high fever, with frequent irregular 
increase and remissions, but not a complete ces- 
sation between attacks as in ague. 

The paroxysm begins in the afternoon, and 
may continue all night, when a remission begins 
and may last eight or ten hours. Each paroxysm 
lasts for twenty-four or thirty-six hours, and may 
continue Repeating itself from one to three weeks. 
In severe forms the remission is less marked; 
delirium like that of typhus fever, and jaundice, 
is very common, and often vomiting of blood. 
The many dangerous local fevers of the tropics 
are usually of this class. 



Remittent Fever. 115 

Treatment. — Same as in yellow fever. Clean- 
liness and removal to a high, dry site if possible. 
Never sleep on the ground*. 

INTERMITTENT FEVER. 
(Ague — The Shakes.) 

This disease is caused by miasma from swamps 
and low-lying marshy places where there is much 
vegetable matter decomposing, more especially 
when it is beginning to dry up. The poison is 
probably a low vegetable organism which does 
not multiply in the body and is not infectious. 
Ague is a prevalent disease in this country, but 
since draining has been so thoroughly carried 
out it has been banished to low-lying sections. 
If the marshes are frozen or completely dried or 
covered to considerable depth with water, ague 
ceases. Exhausting exercise, taking cold, and 
previous attacks increase the predisposition to 
ague. 

About two weeks after exposure to the infec- 
tion a paroxysm of ague occurs, consisting of 
three stages — cold, hot, and sweating. 

The fit begins with a feeling of weakness and 
faintness, the person yawns and stretches his 
limbs and begins to feel cold and chilly. The 
cold and shivering increase, the limbs tremble, 
the lips quiver, the teeth chatter, and the whole 
body often shakes. The skin becomes pale, 
shrivelled, and rough. The features become 



116 Dr. J. Kearts Lectures. 

pale, sharp and shrunken. The fingers are 
shrunken, pale, waxy, have no feeling, and do not 
bleed if wounded. The surface feels cold, and 
the internal organs are congested from the blood 
being driven in. Cough, headache, hurried diffi- 
cult breathing, and depression supervene, with a 
painful sensation round the temples and down 
the back. When nausea and vomiting begin the 
hot stage soon follows. 

After the cold stage has lasted from thirty 
minutes to four hours hot flushes commence and 
gradually extend till the whole body becomes 
hotter than natural (105° to 107° F). The face 
becomes red and swollen, the heart and arteries 
beat violently, with severe headache, breathing is 
freer, fuller, and slower, and thirst is greatly 
increased. The hot stage ends by sweating, 
which begins at the armpits and on the forehead, 
soon extending over the whole body, and is so pro- 
fuse as to soak the bed and linen. The fever then 
gradually abates, the headache remits, and the 
patient falls into a deep sleep, from which he 
awakes, feeling quite well but weak. 

There are three principal varieties of ague: 
Quotidian, when the attack occurs every day; 
Tertian, when it occurs every third day ; Quartan, 
when it occurs every fourth day; and various 
mixed types, such as Double Tertian, when there 
is a fit every day, but only those of every alternate 
day resemble each other in time of occurrence 



Ague. 117 

and duration; Double Quartan, when there is 
a fit in two successive days and the third day 
free, or two fits in one day, one in the morning 
and one in the evening, and two days free, or 
a fit every day. In all the varieties of Quartan 
only the fits on every fourth day resemble each 
other; and also a form in which the fit seems 
replaced by periodic neuralgia. By a continu- 
ance of ague the liver and spleen become greatly 
enlarged (ague cake), the abdomen swollen, the 
blood impoverished, and the countenance 
becomes yellowish. The tongue is white in the 
hot stage, clean in the cold and sweating stages. 
When the disease is about to yield the fit occurs 
later every day, but when it is getting worse it 
occurs earlier. The poisonous malaria is most 
deadly after the dew begins to fall at night and 
lies low ; hence sleeping on the ground floor is to 
be avoided. It is movable by the wind, and 
therefore houses should be built to windward of 
the swamps in malarious districts. Even a small 
surface of water for the wind to pass over, such 
as a running stream, removes the noxious effects, 
probably by absorption. For this reason swamp 
water is dangerous to drink, causing malarious 
fevers. Large leafy trees attract the malarious 
poison and are very dangerous to sleep under, 
but a screen of such trees to windward of a house 
stops the malaria and renders healthy a place 
otherwise uninhabitable. 



118 Dr. J. Kean's Lectures. 

Treatment. — Gold Stage : Warm drinks, hot 
bottles, plenty of blankets. 

Take- 

Fluid extract belladonna, 1 drop every hour 
in water. If pupils dilate, or red spots 
appear on the face, discontinue its use. 
Hot Stage : Cooling drinks, sponging with 
tepid water, light clothing. 

Take 

Tincture of aconite, 2 drops in water every 
hour. 

SWEATING STAGE. 

Take 

Powdered capsicum 15 grains. 

Whiskey 2 oz. 

Mix. 

Dose — One teaspoonful every hour. 
(Intermission.) 

Take 

Sulphate of quinine 10 grains. 

Powdered capsicum 3 grains. 

Powdered leptandrin 3 grains. 

Mix. 

Make three powders. 

Dose — One every two hours, beginning six 
hours before the expected chill. 
In long-continued convalescence : 

Take 

Carbonate of iroD % oz. 

Crystal drips 4 oz. 

Mix. 

Dose — One teaspoonful thrice daily. 
If my directions as here given are closely fol 
lowed, removal from the district, as some physi- 
cians recommend, will be found unnecessary. 



Hyrl rophob ia . 119 

HYDROPHOBIA 
Is a disease peculiar in the first instance to 
animals of the dog and cat tribe. It is one of the 
most dreadful and incurable diseases, but fortu- 
nately it is as rare as it is fatal. Where hydro- 
phobia does occur, usually about four to sixteen 
weeks or longer after being bitten, the scar of the 
bite begins to feel stiff, cold, numb, or tingle, and 
grows bluish red ; very soon there is an indefinite 
feeling of dread and depression of spirits with 
restless sleep. 

There is a spasmodic affection of the muscles of 
the throat and chest, causing spasmodic breathing, 
and stiffness and pain of the neck and throat. 
Suddenly and unexpectedly there is a fit of chok- 
ing induced by an attempt to drink. 

The dread of fluids so characteristic of this dis- 
ease, is entirely due to the dreadful experience 
of the patient on trying to drink. Solid food can 
be swallowed at first without causing spasms, but 
there is distressing thirst and dread of trying to 
satisfy it, wild wandering countenance, and con- 
stant helpless, purposeless restlessness. There is 
a copious flow of viscid saliva which adheres to 
the throat like glue, and causes constant hawking 
and spitting from the dread of trying to swallow. 
The amount of spittle may be taken as a measure 
of the violence of the disease. 

All the senses become highly exalted ; any cold to 
the skin, even a draught of air, a moving of a 




Fig. 8.— Hydrophobia. 



Hydrophobia. 121 

curtain, or any attempt to touch him, causes 
great agony, almost amounting to convulsions. 
The same effect is caused by the approach of 
a light or reflection from a mirror. Hearing is 
also affected, so that the least noise, especially 
that of pouring out fluids, throws him into a 
violent paroxysm. 

At length the mind becomes affected [see Fig. 8j. 
Horror, anxiety, terror, and depression are shown 
on the countenance, and fits of a mad desire to 
tear in pieces whatever opposes him occur, though 
he may strongly repress it. 

The spitting, retching, and vomiting become 
incessant; intense restlessness prevails, and, fall- 
ing into convulsions, the patient expires, or a sud- 
den calm occurs and he dies exhausted. Death 
generally occurs on the second day, the total 
duration, when there is recovery, being three to 
seven days. Few recoveries are known, but some- 
times approaching symptoms of hydrophobia 
have suddenly ceased. In some instances fear of 
the disease induces in those who have been bitten 
a hypochondriacal or maniacal imitation of hy- 
drophobia. 

Treatment is of little avail, but chloroform, 
hydrate of chloral, and the vapor bath are useful 
as moderating spasms. 

The infective poison is chiefly in the saliva, 
and requires to be applied to the broken skin to 
produce hydrophobia. The proportion of those 



122 Dr. J. K earl's Lectures. 

bitten who escape is always comparatively large. 
In one instance mentioned of twenty-one people 
bitten by a mad dog, only one had hydrophobia. 
The part bitten should be cut out or burnt at once, 
and the clothes which are bitten through disin- 
fected before using again. 

A dog which has bitten people and is suspected 
of being mad should not be destroyed but locked 
up ; if it is hydrophobia, the dog soon dies, and 
if not, those bitten have the comfort of knowing 
the bites to be comparatively harmless. 

The first symptoms in the dog are unusual sul- 
lenness, fidgeting, and frequent changing of post- 
ure, loss of and depraved appetite ; it laps its own 
urine, eats straws, litter and rubbish, has a dis- 
position to lick cold surfaces, such as stone or 
iron, and is constantly fighting with its paws at 
the corners of its mouth. The voice becomes 
changed, it has a hoarse inward bark, and another 
perfect bark ending abruptly in a howl. There 
is no dread of water as in human beings, but con- 
stant thirst. The madness may be of a gentle 
kind, where the dog shows great fondness for all 
the persons it knows, or it may be fierce and rag- 
ing, endeavoring to bite everyone it meets, and 
snapping at imaginary foes. Death takes place 
from exhaustion in four to six days. 



LECTURE IV. 

Acute Rheumatism.— Rheumatism.— Gout.— Rheumatic 
Arthritis. — Cancer.— Lupus and Rodent Ulcer. — Lep- 
rosy. — Scrofula. — Rickets. — Cretinism. — Diabetes. — 
Puerpera.— Scurvy. —Anaemia.— Chlorosis. — General 
Dropsy.— Beri-Beri. 



CO^STITUTIO^AIi DISEASES 

Are apt to attack several parts of the body at once 
or in succession. 

RHEUMATIC FEVER. 
(Acute or Inflammatory Rheumatism.) 

IS a specific febrile disorder attended with in- 
flammation of the fibrous tissues of the body, 
especially of the joints and heart. The parts 
attacked are thickened, and opposing surfaces 
tend to adhere. 

It occurs most frequently between the ages of 
15 and 40, and is most apt to attack those having 
hereditary predisposition or who have had prev- 
ious attacks. The special blood poison is sup- 
posed to be lactic acid which is formed in the 
body. The attack is usually brought on by ex- 
posure to cold and damp, especially by evapora- 
tion from wet clothes after severe exertion. 



124 Dr. J. Kean's Lectures. 

Fever generally precedes the local symptoms 
for twenty-four to forty-eight hours. The com- 
plexion is pale and sallow, and the eyes dull and 
yellow There is great heat of skin, 100° to 103° 
F., with copious acid perspiration having a sour 
disagreeable odor. The pains in the jmnts are 
always worse if there is no perspiration. 

The pulse is 90 to 100 ; there is great thirst and 
constipation. The tongue is white, and the urine 
is scanty, high-colored, and deposits a sediment 
like brick-dust. 

Soon after the fever appears the patient com- 
plains of pain in one or usually several joints, 
moderate at first, but which quickly and steadily 
becomes severe. The affected joints are hot, 
more or less swollen, and occasionally red, but 
the degree of swelling and the pain are not always 
in proportion, At the height of the disorder in 
severe cases the patient presents a pitiable spec- 
tacle ; he lies motionless on his back, afraid to 
move, and dare not even raise his hand to wipe 
the drops from his brow ; even the weight of the 
bedclothes increases the pain and induces groans 
and complaints. If he sleeps it is short, and he 
wakes up with increased suffering. As the dis- 
ease progresses it attacks joints that have been 
previously free, and reaches its height in them 
while it is disappearing from those first attacked 
(Metastasis). After several migrations it may 
again attack its original seat, but the most serious 



Inflammatory Rheumatism. 125 

migration is when it attacks the heart, which oc- 
curs in less than half the cases of rheumatic 
fever. The patient's countenance becomes anx- 
ious, the breathing distressed and hurried, pain is 
complained of over the heart, which is increased 
by pressure, movement, or breathing, and palpi- 
tation occurs. The stethoscope or ear applied to 
the chest may hear a rubbing to and fro sound 
like creaking leather In many cases there are 
no symptoms beyond the sounds heard by the 
stethoscope. The tendency to attack the heart is 
greater, the more numerous the joints affected. 
In a few cases there may be pleurisy, inflamma- 
tion of the lungs or of the brain coverings, caus- 
ing delirium. When the temperature rises to 
103°, and the pulse to 120 or 130, the patient is in 
great danger. The fever generally continues 
from ten to fourteen days, and the rheumatism 
from four to six weeks, but it may leave chronic 
rheumatism which may last for months or years. 
Relapses are very apt to occur. As a rule in a 
person otherwise healthy it terminates favorably, 
leaving the patient pale and bloodless. 

Treatment. — Rest in bed, and give acetate of 
morphia, 3^ grain every few hours ; avoid strong 
food ; followed by 
Take 

Tincture of aconite 30 drops. 

Tincture of gelsemium 45 drops. 

Water 2 oz. 

Mix. 



126 Dr. J. K earl's Lectures. 

Dose — One teaspoonful every three hours, and 
apply the following to affected part to remove 
pain: 

Take 

Muriate of ammonia 1 oz. 

Solid extract of belladonna % oz. 

Boiling water 1 pint. 

Mix. 

(See precautionary rules, Lecture XVII.) 

After remission takes place, give salacine, 5 
grains three times a day. As a mild purgative 
give confection senna, one tablespoonful, followed 
by tincture of iron, ten-drop doses in water, three 
times a day. Average required treatment is from 
eight to ten days. Our main reliance is in the 
alkaline spring, procured for the express purpose 
of drinking and bathing in all cases of rheu- 
matism and diseases of an acid diathesis. (See 
Lecture XVI.) 

RHEUMATISM. 

Many different varieties of rheumatism have 
been described, according to the part attacked. • 
The following division will be found practically 
useful : 

Gonorrhmal Rheumatism — (See G. B. published 
separately). 

Muscular Rheumatism — Is usually acute, and 
entirely disappears after a short duration, but 
occasionally it remains fixed in some muscles. 
The pain is tearing or stretching, and is made 
worse by moving, but diminished by regular pres- 



Rheumatism. 127 

sure supporting and relaxing the affected muscles. 
It is generally better in the morning after the 
repose of the night, and increases with fatigue; 
and towards evening it is usually irritated by cold 
and dampness, and relieved by dry warmth. The 
skin over the aflected part is not hot, red nor 
swollen. 

Lumbago. — Rheumatism of the loins is remark- 
able for its severity and sudden attack ; the person 
suddenly makes a wry face, cries out and places 
himself in the most peculiar positions to favor 
the painful parts. 

Rheumatism of the shoulders and arms. — Stoop- 
ing and moving the arms are painful. 

Rheumatic headache. — Moving the scalp causes 
pain. 

Stiff neck. — The head is twisted to one side, and 
movement causes great pain ; it is usually caused 
by exposure to a draught. 

Stitch in the side {Pleurodynia). — The pain is 
felt at one point, and there is catching of the 
breath. Breathing, coughing, sneezing and bend- 
ing cause great pain ; it may appear like disease 
of the lungs, but there is no cough, and pressing 
the finger between the ribs from before backwards 
causes pain. 

Sciatica. — (See Lecture Y.) 

Growing pains. — Chiefly in the calves of the 
lower limbs. 

Wandering pains — Are apt to follow acute dis- 



128 Dr. J. Kean's Lectures. 

eases, especially scarlet fever and dysentery, and 
in people long exposed to changes of weather, as 
soldiers and sailors, or in people predisposed to 
rheumatism without any special cause. It is 
more especially important to the medical man to 
recognize them, as if he fails to prescribe appro- 
priate treatment the patient in his contempt for 
medicine will hasten to try the pure air and good 
diet of some hydropathic establishment, and then 
circulate reports of his extraordinary cure, " after 
having been given up by the faculty." 

Treatment. — As in acute rheumatism, rest and 
warmth to the affected muscles. Overlapping 
layers of broad strips of adhesive plaster of any 
kind spread on doeskin, over the affected side, 
and a flannel bandage over all. 

Gentle rubbing of the affected part with a 
warm hand, and a little soap liniment; some- 
times a warm bath for ten minutes is of use ; the 
body must be rubbed thoroughly dry with a warm 
towel. 

For wandering or obstinate pains, half a tea- 
spoonful each of cream of tartar and sulphur, 
with 10 grains of guaiac resin, and a teaspoonful 
of syrup of ginger mixed with honey, and taken 
with a glass of water in the morning. 

Chronic Rheumatism is the most common form 
of rheumatism. The knee, ankle, elbow, hip, or 
shoulder joints are those which usually suffer 
from chronic pain, stiffness, and swelling. It 



Rheumatism. 129 

generally attacks only one joint, usually the right 
knee, or very few joints if more than one, and 
rarely changes from one to another, as acute 
rheumatism. It appears in two forms. In the 
first form single joints are often for months or 
years the seat of constant pain, which is increased 
by pressure, but particularly by moving the part, 
and severe paroxysms of pain occur sponta- 
neously, particularly at night. If we place the 
hand on the joint while moving we often perceive 
a distinct crackling; occasionally the joint is 
swollen from containing fluid of an acid reaction, 
and the muscles are more or less wasted from 
want of exercise. The second form, Synovial 
Eheumatism, consists of a series of sharp attacks 
occurring at short intervals, always in the same 
joint Persons suffering from this form often 
become rheumatic at every change of weather, 
and are possessed of a very disagreeable barome- 
ter. Attacks may also be produced by damp feet 
or draughts. There is slight fever accompanied 
by perspiration; the joint is swollen, sensitive to 
pressure, and painful when moved. 

Predisposing causes, i. e., causes which favor 
an attack of chronic rheumatism, are hered- 
itary influence, effects of any kind of rheuma- 
tism, middle age, and general debility. The 
attacks are usually brought on by cold and damp, 
especially evaporation from wet clothes after 
severe exercise. It is most apt to affect any 



130 Dr. J. Kean's Lectures. 

part that has been weakened or injured, as a 
sprained or bruised joint, or the limb that is 
most fatigued. Prolonged and repeated attacks 
lead to deformity of the joints, and not unfre- 
quently to dislocation. Rheumatism is generally 
associated with derangement of the digestive 
organs. 

TREATMENT. 

Take 

Tincture of macrotys 1 oz. 

Tincture of guaiacum 1 oz. 

Fluid extract colchicum 1 oz. 

Mix. 

Dose — One teaspoonful three times a day. 
(See precautionary rules, Lecture XVII.) 
Muriate of ammonia and belladonna to remove 
pain, as in acute rheumatism ; to be followed by : 
Take- 
Iodide of potash 1 oz. 

Compound syrup of stillingia 1 pint. 

Mix. 

Dose — One teaspoonful thrice daily. Continue 
for a month to prevent a relapse. 

The affected joints should be kept at rest and 
surrounded by a layer of cotton wadding covered 
with gutta-percha tissue or any waterproof 
material. The Turkish bath is often of great 
benefit, especially at first — provided the heart is 
unaffected. A course of hot baths may be of 
much use, but the patient requires to be very 
carefully and thoroughly dried after each bath. 
If the joints are very painful, poultices with 20 



Acute Gout. 131 

drops of laudanum sprinkled on them may relieve 
the pain. 

Regulation of the food and habits during health 
is important to prevent repeated attacks. Occa- 
sionally rheumatism resists all kinds of treatment 
for a long time. Flannel should be worn next 
the skin, and all exposure to damp or damp feet, 
especially when fatigued, should be carefully 
avoided. (See alkaline spring, Lecture XVI.) 

ACUTE GOUT 
Is a specific form of inflammation in which as 
a rule the first joint of the great toe is first and 
chiefly attacked. Gout may be hereditary or 
acquired. It occurs chiefly in men who eat great 
quantities of animal food and indulge freely in 
malt liquors and wine without taking sufficient 
exercise. 

The premonitory symptoms are indigestion, 
palpitation, constriction of the chest, and profuse 
perspiration ; but they are usually so slight as to 
attract no special attention; hence the attack 
surprises the patient. After he has gone quietly 
to sleep he is awakened soon after midnight by 
a severe burning piercing pain in the first joint 
of the great toe, immediately succeeded by chills, 
and slight pain, which abate as the pain increases. 
The pain rapidly becomes unbearable, the af- 
fected joint feeling as if held in a vise, and so 
exquisitely painful that the patient cannot en- 



Acute Gout. 133 

dure the weight of the bedclothes nor the shak- 
ing of the room from a person walking quickly 
in it; he sighs and groans and is perpetually 
shifting his foot from place to place. Soon after 
the attack begins the aflected joint swells, and 
the skin over it becomes tense, red and shining; 
there is fever with a full pulse, dry skin, intense 
thirst, scanty high-colored urine, and very irrit- 
able temper. The pain goes on increasing till 
evening and does not abate till two or three next 
morning, about twenty-four hours from the com- 
mencement, when the patient falls asleep in a 
gentle perspiration ; the following day the pain 
is endurable, but becomes worse towards evening, 
passable days, alternating with bad nights for 
from one to two weeks, when the patient recovers. 
As the paroxysm is leaving a violent itching 
seizes the foot especially between the toes, and 
the skin peels off. After recovering from the 
pain and sleepless nights, the patient generally 
feels in better health than before the attack; 
hence a fit of gout was long considered to be 
healthy, the real reason being that the excess of 
food and drink was discontinued, and the wasting 
of the body increased. At first the interval between 
the attacks lasts a year or more, according as the 
patient reforms his habits, taking more exercise 
and less food, but as the paroxysms recur the 
intervals become shorter and tend to deviate from 
the ordinary type as the gout becomes chronic. 



134 Dr. J. Kean's Lectures. 

The blood contains an excess of uric acid, which 
is deposited as " chalk stones " in and around the 
affected joint, and various local affections are 
developed, such as flying pains or gouty twinges, 
a disposition to grind the teeth, daily paroxysms 
of intense heat of the nose, which is at first 
bright red, soon becoming purplish, and which 
continues for three or four hours — tic douloureaux 
and sciatica. These affections are always greatest 
when the stomach is much deranged. 

Treatment. — Ten drops of colchicum wine 
and the bulk of a small bean of bicarbonate of 
soda in a glass of water every four hours. Vary 
the quantity of these remedies according to the 
obstinacy or mildness of the difficulty. (See 
alkaline spring, Lecture XVI.) When the pain is 
severe six grains of Dover's powder every four 
hours. The affected joint should be wrapped in 
cotton wool or flannel, and a piece of flannel 
saturated in a warm lotion of twenty drops of 
laudanum in a wineglassful of warm water may 
be laid over it. 

Cold applications must be avoided, though they 
often give instant relief, as they may cause the 
inflammation to leave the joint and attack the 
heart or brain and produce sudden death. 

Chrome Gout. — Chronic gout does not materi- 
ally differ from acute, but the attacks are longer, 
the intervals shorter and less perfect, and there is 
a greater tendency to extend to the internal 



Gout. 135 

organs. Several joints may be affected at the 
same time or in succession. The attack is pre- 
ceded by acid indigestion, flatulence, and consti- 
pated bowels; restless sleep, palpitation, and 
perspiration. The patient suddenly feels a blow 
v as if the foot was broken in pieces with a large 
sledge, so that he wakens crying out with agony. 
The succeeding paroxysms are less painful; 
instead of the usual external pain, sickness, dis- 
tress in the abdomen, and frequently diarrhoea 
succeed. The swelling and redness develop more 
slowly in chronic gout. The redness is not so 
intense, and the swelling is more diffuse and 
softer and remains after the skin peels. Chalk 
stones are more common in chronic gout, and 
after repeated attacks the part becomes thicker 
by new deposits which cause pain, difficulty of 
motion, weakness, and deformity of the parts, 
and may even cause dislocation. 

Atonic Gout. — The weak system is not in a con- 
dition to develop an attack of ordinary gout. 
The joints enlarge and the tissues and ligaments 
are thickened, yet if the patient be kept quiet he 
suffers no pain ; but is troubled with indigestion, 
sickness, flatulence, cramps, low spirits, fainting 
and breathlessness. The slightest causes, as cold, 
changes of weather, excitement, or indiscretion 
in diet, will superinduce these symptoms, some- 
times with pain in one or more joints, iike a 
commencing fit of gout. 



136 Dr. J. Kearts Lectures, 

Retrocedent Gout. — Is when some iDternal organ 
is affected on the disappearance of the disease 
from the joints. Gout in the stomach causes 
severe pain and violent vomiting ; in the brain it 
causes severe headache, dizziness and vomiting, 
or like a fit of apoplexy. Gout in the heart 
causes irregular feeble pulse, breathlessness and 
fainting; in the spinal marrow, paralysis; and 
in the lungs, asthma. 

Treatment — During the fit is the same as in 
acute gout ; colchicum must not be continued for 
more than three weeks at a time. If gout has 
shifted to an internal organ, a large mustard 
poultice over the joint previously affected ; during 
the intervals a moderate allowance of food ; meat 
to be taken only once a day, and all alcohol, 
especially beer and wine, as well as tea and 
coffee, are to be avoided ; a moderate amount of 
exercise, and a considerable amount of pure 
water as a drink, are beneficial. Chronic gout 
has a tendency to produce diseases of the kidneys. 
(See alkaline spring, Lecture XVI.) 

CHRONIC OSTEOARTHRITIS, 

Is characterized by pain, stiffness and deformity 
of one or more joints, with deposition of new 
bone round them. The joint becomes swollen 
and misshapen, the cartilages on the ends of the 
bones disappear, leaving a smooth hard surface 
like porcelain. The disease develops slowly, 



Chronic Osteo- Arthritis. 137 

usually between the tweutieth and fortieth } T ear ; 
a stationary period may occur in its progress, but 
never a disappearance of the existing deformity. 
The disease generally commences in both hands 
and passes to both feet. There is slight pain in 
the affected joints, which is increased by pressure 
or by motion, and if the hand be laid on it while 
in motion, a crackling is felt, the joint containing 
little or no synovial fluid. The Angers are drawn 
to the little finger side of the palm, and overlap 
each other. Patients with this disease may attain 
extreme old age. 

Treatment. — It must not be treated either as 
gout or rheumatism. Warm baths, ten grains ot 
Dover's powder at bedtime to promote action 
of the skin, good diet and a moderate allowance 
of wine, four grains daily of citrate of quinine 
and iron. Warm clothing and occasionally paint- 
ing over the affected joint with compound 
tincture of iodine. 

CANCER 

Cancer, in the popular sense of the word, in- 
cludes malignant tumors, and may be defined as 
a deposit or growth that tends to spread indefi- 
nitely in the surrounding tissues, and to repro- 
duce itself in remote parts of the body ; a contin- 
ual feverish state (cachexia) and increasing wast- 
ing are set up ; the face becomes pale and anxious, 
with a slight leaden or dirty yellow hue, the 
features become pinched, and have a sunken 



138 



Dr. J. Keari's Lectures. 



cadaverous look, the pulse becomes frequent, and 
the pains severe. At length there is nausea, im- 
paired digestion and a tickling cough, severe 
darting pains shoot through the affected part, the 
breathing becomes hurried, and death occurs. 
There is a marked hereditary predisposition in 
more than a third of cancer cases. The following 
are the principal varieties of cancer : 

Scirrhus — Hard Cancer. — Is the most frequent 
form of cancer, and is most 
common between the ages of 
forty-live and fifty. Its fav- p 
orite seat is the female breast ; f 
[see Fig. 10] it may last from |[. JP2fc * V s \ 
six months to twenty years or i x ki* v -^ % 

more, but as a rule it ter- 11 —— — ■- ■ — L 

„ , . Fig. 10. — Scirrhus 

mmates fatally within four Cancer. 

years after it is first observed. It has two stages, 
a hard and a stage of softening. It is usually 
discovered accidentally by the patient, as a hard 
firm lump in one breast which gives no pain, is 
freely movable, and excites uneasiness only by 
M its continuing to grow, but 
oftentimes there are darting 
pains from the first. After a 
flS short time it ceases to be 
|H freely movable, from drag- 
ging in and absorbing sur- 

'' rounding tissues [see Fig. Ill ; 

Fig. 11.— Hard , & , £ , to -" 

Cancer. presently the surface becomes 





Cancer. 



139 



knotty, the nipple is drawn in and sunken, the 
superficial veins are enlarged and tortuous; the 
skin becomes a purplish red, stretched, and shin- 
ing. Ulceration commences as a superficial crack 
or small ulcer, and rapidly increases, causing a 
deep ragged sore with turned-out edges, the dis- 
charge of which is irritating, thin, bloody, pro- 
fuse and foetid ; sooner or later the neighboring 
lymphatic glands become affected, and secondary 
cancers appear in the internal organs. 

There are often hard lumps [see Fig. 12] in the 
breast, frequently associated 
with darting pain, which are 
not cancer but due to chrooic 
inflammation of a gland 
which becomes hard and 
excites uneasiness, especial- 

FlG * 12 clf cer NDATIY ly if accompanied by neu- 
ralgia of the breast. No time ought to be lost in 
consulting a skillful surgeon in such cases, to 
determine its true character. 




Take- 



TREATMENT. 



Terchloride of carbon 20 grains. 

Compound syrup of stillingia 4 oz. 

Mix. 

Dose — One teaspoonful three times daily. Also 
on alternate days with the above : 

Take 

Iodide of potash 3^ oz - 

Syrup of sarsaparilla 4 oz. 

Mix. 



140 



Dr. J. Kean's Lectures. 



Dose — One teaspoonful thrice daily. Or removal 
by a skillful surgeon before the glands are a fleeted 
and while it is still movable. Charcoal poultices 
to the ulcer or chloride of zinc lotion, with mor- 
phia .injections to subdue the pain. There are 
many varieties of hard cancer. 

Medullary — Soft Cancer. — Generally attacks the 
solid internal organs or bones, and is rare in the 
breast. It is the only cancer which is common in 
early life. Death generally happens within two 
years of its first occurrence. The general symp- 
toms (cachexia) are the same as in hard cancer ; 
when ulcerated it protrudes in large masses [see 
Fig. 13], which bleed copious- 
ly ; there may be little pain, 
or it may be very severe ac- 
cording as the cancer occurs 
in yielding or in firm tissues. 

Treatment — As above in 
this form of cancer. When Fm - 13 c~lS LLARY 
removed they are apt to spring up and enlarge 
in all directions. Treatment must, as a rule, be 
to relieving the symptoms ; occasionally, but very 
rarely, both hard and soft cancers are spontan- 
eously cured, the pressure caused by their rapid 
growth destroys them, and they are cast off, or 
may dry up and become absorbed. Cancer is 
rarely seen in consumptive people ; and consump- 
tion often cures them. 

Epithelioma — Is a form of cancer which occurs 
almost solely on the skin and mucous membrane. 




Cancer. 



141 




, Fig. 14.— Epi- 
lt commences as a small thelial Cancer 



Its usual seat is near the orifices of the body, par- 
ticularly on the lips. [See Fig. 14.] When once 
it has commenced its tendency is as 
fatal as the other forms, but it re- 
mains much longer quiescent. It is 
often caused by long-continued ir- 
ritation, as a short hot pipe in can- 
cer of the lower lip, and by the con- 
tact of soot in chimney sweepers' 
cancer. 

hardness, pustule, or wart, or as a little scab, 
which soon becomes ulcerated, leaving an irreg- 
ular open sore, with grey or bloody base, or 
covered with crusts, and from the edges a foetid 
thin discharge exudes, accompanied by burning 
pain and general cancerous symptoms. It tends 
to infect the neighboring lymphatic glands, and 
death is by exhaustion or from blood-poisoning. 
* Treatment. — Same as preceding, or early ex- 
cision, which may be a complete cure. When far 
advanced, belladonna plaster around it, and opium 
to soothe the pain. 

Lupus — Is a spreading destructive 
inflammation of the skin, [see Fig. 
15,] of the face usually. It is most 
common between the ages of 10 and 
20, in badly nourished scrofulous 
people. There are two varieties. 

Chronic Lupus. — It appears as a 
glistening pimple or pimples,which 





142 Dr. J. Kecui's Lectures. 

are covered with detached scales, and can be eas- 
ily made to bleed ; the scales form scabs which 
grow thicker and broader [see Fig. 16], and may 
ulcerate underneath, leaving a 
white shining scar when it heals. 
The disease is very obstinate, and 
may last for months or years. 

Spreading Lupus — (exedens) — In 
which the nodules ulcerate and 
form deep, comparatively large Fig. 16.- 
and rapidly spreading ulcers which Lupus Cancer. 
may be healing at one part and increasing at 
another. 

Rodent Ulcer — Is a disease that usually begins 
from one nodule, and forms a very deep and des- 
tructive ulcer of an irregular circular shape, of a 
dull yellowish red; the base is dry and shining, 
and feels tough and hard, while the surrounding 
skin is healthy; it usually occurs in the latter 
half of life. 

Treatment. — Internal remedies same as in 
hard cancer. 

When there is destructive ulceration, the ulcer 
must be destroyed by excision, or some strong 
escharotic, such as nitric acid. In all the patient 
should have pure air, nourishing food, and two 
grains of carbonate of iron thrice daily after 
food. If there is a syphilitic taint, (see G. B. 
published separately.) 



Leprosy. 143 

LEPROSY 

Is a constitutional non-contagious hereditary 
affection of a chronic nature, showing itself as 
shining dusky red tubercles of different sizes. 
The skin is thickened, wrinkled, rough, greasy, 
divested of hair, and the perspiration highly 
offensive; the skin loses feeling, and there is a 
tendency to ulceration, from which the fingers 
and toes or hands and feet may drop off. The 
eyes become fierce and staring, and the voice 
hoarse and nasal. 

Treatment. — Attention to the general health ; 
milk warm from the cow; iodine or sulphur, 
vapor and Turkish baths. 
Take 

Fluid extract of corydalis 3 oz. 

Sulphate of quinine 3€ oz - 

Citrate of ammonia and iron % oz. 

Crystal drips 3 oz. 

Sherry wine 10 oz. 

Mix. 

Dose — One dessertspoonful three times a day, . 
before meals. (See precautionary rules, Lec- 
ture XVII.) 

SCROFULA. 

(Struma.) 
Is a morbid state of the system characterized 
by a remarkable liability to low forms of inflam- 
mation of the glands, joints, ears, membranes of 
the eyes, skin eruptions, and a tendency to pro- 



Scrofula. 145 

duce tubercle causing consumption. Scrofula 
may be either hereditary or acquired; in both 
cases the primary disorder is a certain kind of 
dyspepsia. Acquired scrofula is generally the 
result of improper food, impure air, and want of 
sufficient exercise. Feeding infants solely from 
the breast instead of milk is a frequent cause. 
Hereditary scrofula may be due to the parents 
being scrofulous, or suffering from cancers, con- 
sumption, or some other malady, and presents two 
types. In one there is an unusually large head, 
coarse features, and thick chin, a hard swollen 
abdomen, enlarged glands in the neck, and flabby 
spongy flesh ; in the other the skin is of remark- 
able whiteness and reddens easily, with blue 
veins visible through it ; the lips and cheeks are 
deep red, and the white of the eye is a pearly 
bluish white, giving a swimming appearance to 
the eye ; the muscles are thin and soft, the features 
are finely cut, the teeth long, narrow, and bluish 
white 3 and the hair is soft and usually light col- 
ored. [See Fig. 17.] Children of this type are 
unusually intelligent and precocious, often beauti- 
ful, physically, mentally and morally, and the}- 
mostly die young of consumption. The most 
usual effect of scrofula is to cause slow painless 
inflammation of the glands of the neck which 
suppurate, and the pus perforates through the 
skin, leaving an ulcer which heals with great 
difficulty. The pus is thin and watery and con- 



146 Dr. J. Kean's Lectures, 

tains flakes of curd-like appearance. The pro- 
gress of scrofula is tedious and treacherous, and 
is marked by periodical alternations of improve- 
ment and aggravation, often resisting treatment 
for a long time. 

Treatment. — For scrofulous infants a wet 
nurse, or if one cannot be procured, milk warm 
if possible from the cow. For others than 
infants, a supply of pure fresh air ; active exer- 
cise in the open air; a mild uniform climate, dry 
soil, and pure water; flannel next the skin; 
waterproof coats and boots or shoes should be 
avoided; sufficient regular sleep; bathing or 
sponging of the body ; milk, warm from the cow, 
should be a great part of the food. If there is 
enlargement of the glands, compound syrup of 
stillingia two tablespoonfuls daily for three weeks 
at a time, followed by a week's intermission if it 
requires to be continued. Iodide of potassium, 
four grains daily for a week, and then a week's 
intermission. Any complications must be treated 
separately. There is very little power of resist- 
ance to disease in the scrofulous state. 

RICKETS 
Is a constitutional disease peculiar to early 
childhood, which frequently commences between 
the seventh and eighteenth month after birth, and 
appears when the child begins to walk. The 
bones as they grow remain soft like gristle from 



Rickets. 



147 



the earthy salts not being deposited. It is pre- 
ceded for several weeks or months by an 
unhealthy state of the system, often shown by a 
form of indigestion and diarrhoea. Rickets is 
sometimes hereditary and is favored by improper 
positions assumed by children [see Fig. 18] while 
at study or unwholesome food ; it is most common 




Fig. 18 — Eickets. 
among the scrofulous children of the poor. The 
first symptom showing that rickets has succeeded 
the diarrhoea and wasting in infants is the pain 
they suffer when they attempt to move their limbs 
or when they are moved by anyone. " Children 
whose greatest pleasure had been to kick 



148 Dr. J. Kearts Lectures. 

and double up their nether extremities, lie 
quiet, their thin limbs held straight out as if 
afraid to move; they cry at every motion, and 
whimper for fear of being hurt when persons 
they had formerly loved approach them." If the 
disease end in recovery, the first sign of improve- 
ment is a decrease of emaciation, the loose skin 
fills again, the wrinkled old face becomes smooth, 
and the. protuberant abdomen decreases in size. 
Curvatures and partial fractures are most likely 
to occur when the child is recovering and sits up 
or attempts to walk. Older children do not suffer 
pain, nor is rickets preceded by dyspepsia in 
them. 

Treatment. — Pure fresh air. The food should 
be chiefly milk warm from the cow, or boiled 
with a fourth part of lime water added. Once a 
week a dose of rhubarb, soda, and calumba, 1% 
grains of each for a child under one year. 

To guard against curvature of the bones, high 
pillows and feather beds should be avoided; 
sitting up in bed for any length of time and run- 
ning about should be forbidden. When convales- 
cent, 

Take 

Phosphate of iron, 2 grains daily. 

OSTEOMALACIA. 
Bones which have been hard soften from re- 
absorption of the lime salts. It is a rare disease, 
and occurs chiefly in women after confinement. 



Cretinism. 149 

It appears with boring tearing pain in the loins, 
and great pain on moving, and is exceedingly 
fatal. Treatment is confined to preventing distor- 
tions. 

CRETINISM. 

A form of idiocy associated with imperfect 
development and deformity of the bodily organs, 
especially the head, and having a close connec- 
tion with goitre. Cretins are of small stature, 
and have a large head flattened at the top. The 
countenance is vacant, the mouth gaping and 
slavering, the tongue protruding, the speech 
defective, and in complete cretinism deaf-mute- 
ness and deficiency of general sensibility, with 
absence of reproductive power. 

Treatment. — Improve the general health, men- 
tal training, and moral control. 

DIABETES 
Is a constitutional disease characterized by an 
excessive discharge of pale straw-colored urine 
containing more or less sugar, excessive thirst, 
and progressive emaciation. It occurs more fre- 
quently is. the male than in the female sex, in the 
proportion of three to one. The beginning of the 
disease is generally gradual and unobserved; 
there is a sense of general discomfort, with con- 
stant thirst and increase of urine, the patient 
having to rise several times in the night to void 
water ; the general health begins to give way, with 



150 Dr. J. Kean's Lectures. 

intense thirst, there is a constant sense of sinking 
at the stomach, the appetite is voracious or capri- 
cious, the skin harsh and dry, and the patient 
becomes greatly emaciated and loses sexual desire 
and power. (See G. B. published separately.) 
The extremities are cold with a sense of burning 
in the hands and feet, the bowels become costive, 
and the stools hard and dry. The breath has a 
peculiar faint smell like May-apples. 

In advanced cases there is increasing weakness ; 
the bones of the gums are absorbed, and the teeth, 
loosened in their sockets, are apt to fall out. 
There is a tendency to the formation of cataract 
in the eyes, or to the formation of boils, and in 
many cases consumption of the lungs. The aver- 
age duration of diabetes is about three years; 
complete permanent cure is rare. Many patients 
pass a pound or even two pounds of sugar daily 
in the urine, so that in a few months they will 
void their own weight of sugar. 

Tests. — The density of diabetic urine varies 
from 1030 to 1050, healthy urine being 1015 to 1025. 
The specific gravity is most easily taken by a 
little glass instrument called a urinometer, which 
is set floating in the urine, and the level of the 
urine on the stem read off gives the density ; in 
distilled water at 60° F. it should float at zero, 
and each degree represents an additional thou- 
sandth part by weight in the same bulk of fluid, 
distilled water being taken as 1000. 



Diabetes. 151 

For chemical tests a test tube and spirit lamp 
or gas flame are required. 

1st. Fill about an inch of the test tube with 
the suspected urine and add an equal bulk of 
caustic potash solution and boil it, when if sugar 
is present the liquor becomes a dark sherry-color. 

2d. — To about an inch of urine in the test tube 
add a few drops of solution of sulphate of copper 
and a little caustic potash solution, and apply the 
flame to the upper part of the fluid by inclining 
the tube. If there is sugar a yellowish-red pre- 
cipitate is formed. 

3d. — Potassio-tartrate of copper also gives this 
precipitate. All the foregoing are occasionally 
liable to failure, therefore it is well to try more 
than one. 

4th. — Fix a piece of dry German yeast in a 
test tube and fill it with urine ; invert it over a 
small dish of the urine and let it stand in a warm 
place ; if there is sugar, fermentation goes on, gas 
rises, and the urine falls in the tube. The tests 
for sugar should be tried several times at intervals, 
as it may be merely a temporary constituent of the 
urine. As a rule the second test will be sufficient. 

Treatment — Is chiefly dietetic : Abstain from 
all food containing sugar or starch. The food 
should consist of meat, eggs, fish, shellfish, green 
vegetables (not blanched), such as lettuce, spin- 
ach, watercress, artichoke, cabbage, and bran- 
bread, gluten crackers, with skimmed milk; if 



152 Dr. J. Kean's Lectures. 

desired, very weak brandy and water may be used. 
Sugar, pastry, confectionery, potatoes, carrots, tur- 
nips, parsnips, beet-root and radishes, as well as 
rice, sago, tapioca, etc., should be avoided. 

As diabetic persons are very apt to take cold 
and have inflammations, especially of the lungs, 
the clothing should be warm, and flannel worn 
next the skin. Eegular exercise should be taken 
in the open air. 
Take 

Fluid extract of corydalis compound, one- 
half teaspoonful three times daily, or make de- 
coction as follows : 
Take' 

Dock-root % oz - 

Boiling water 1 pint. 

Mix. 

Dose — One wineglassful thrice daily. 

Opium may be required as a sedative in half- 
grain doses night and morning, or codeia in half- 
grain doses may be successful. 

Diabetes Insipidus. — The symptoms are the 
same except that there is no sugar in the urine, 
the specific gravity of which is about 1005, and 
which is passed in great quantity, from ten to 
thirty pints or more in 24 hours. The treatment 
should be as in diabetes, followed by carbonate of 
iron, 3 grains, with ordinary good food and warm 
flannel clothing. (See remarks following the 
analysis of urine, Lecture XI.) 



Purpura. 153 

PURPURA. 
(Purple Color.) 

Purpura is a disease characterized by small 
purple spots of effused blood under the skin, 
which are not effaced by pressure and unattended 
by fever. General disorder of the constitution 
precedes the appearance of the spots; there is 
oppressive weariness, faintness, and gnawing 
pains at the stomach; the appetite is weak or 
there is a craving for food, which lies like a 
weight on the stomach when eaten ; the tongue is 
yellowish and the complexion pale or bloated 
with swelling below the eyelids. There is often 
giddiness, palpitation, and constipation of the 
bowels. When attended with bleeding from some 
mucous surface, as the nose, it is called hsemor- 
rhagic purpura. 

The cause is not known. 

Treatment. — Milk, fresh fruit and animal 
food; quinine, 2 grains daily, and turpentine, 8 
drops twice a day. 

HEMORRHAGIC DIATHESIS. 

Hemorrhagic diathesis is a peculiar state of 
constitution, when the most trifling wound or 
scratch is liable to give rise to profuse and even 
fatal bleeding. It is generally hereditary, and is 
usually accidentally discovered, as by drawing a 
tooth causing severe and dangerous hemorrhage. 



154 Dr. J. Kearis Lectures. 

Treatment. — The only treatment of any avail 
is to avoid wounds and improve the general 
health, when it may possibly be outgrown. 

SCURVY 

Is a complex morbid state caused by long- 
continued privation of fresh vegetables or their 
juices, and aggravated by cold and damp, great 
fatigue, and despondency of mind. The earliest 
symptoms are a sallow dusky hue of the skin, 
particularly of the face ; wandering pains in the 
limbs, weariness and depression of spirits. The 
eyes are sunken and surrounded by a bluish ring. 
The gums become soft, spongy, and swollen, and 
bleed # very easily. A small purple eruption 
appears on the lower limbs, and the slightest 
pressure or blow causes an extensive bruise. As the 
disease develops large yellow patches which be- 
come purple appear under the skin of the nether 
limbs, especially near old scars; the skin feels 
rough and dry, with raised scales, and perspiration 
is diminished or suspended. The purple spots tend 
to form ulcers, old sores break out afresh, and 
even the joinings of bones which had been frac- 
tured are dissolved. The tongue is white, broad 
and flabby, the breath offensive and stools 
pale. The teeth become so loose that they may 
fall out, and profuse hemorrhage occurs from the 
gums, nose, mouth, stomach or bowels. Death 
may occur from diarrhoea, dropsy, or bleeding. 



Scurvy. 155 

I have seen scurvy in the western ranches 
in harvest workers who had been from home and 
lived chiefly on bread, bacon and tea, without 
vegetables or fresh meat. The gums were swollen, 
in one, ulcerated, chewing causing great pain. 
The disease rapidly subsided after an addition of 
fresh milk and lemons to their dietary. 

Treatment — Lemon juice, fresh fruits, milk, 
cresses, juice of raw potatoes and onions. All 
ships should carry good lime juice, as preserved 
vegetables have not the virtue of fresh ones. 

ANAEMIA 

Is a morbid state of the blood, which becomes 
thin, watery, and deficient in red corpuscles. It 
seldom occurs alone, but is generally caused by 
some other affection. The lips and gums are 
pale and bloodless ; the face is pale, waxy, and 
blanched in appearance ; the small blue collapsed 
veins are very obvious through the pale skin ; the 
hands and feet are cold, the circulation is feeble, 
and the heart's action irregular, producing palpi- 
tation ; a humming sound may be heard in the 
jugular vein in the neck, and murmurs may be 
heard over the heart, caused by the thinness of 
the blood. 

Partial dropsies (oedema), causing swelling of 
the feet and fainting, are very apt to occur, and 
the patient is usually thin, weak, languid and in 
low spirits. Indigestion is apt to prevail, from 



156 Dr. J. Kean's Lectures. 

want of proper blood to supply the digestive 
juices. Bright's disease, cancer and suppuration 
are causes of persistent anaemia. 

Treatment. — Remove the cause, if possible; 
give nourishing food, change of air, exercise and 
tincture of iron, 15 drops in a tablespoonful of 
infusion of quassia, twice a day, after food ; for 
delicate stomachs which will not tolerate tincture 
of iron, give lactate of iron, 4 grains twice a day 
after food. For indigestion, 2 grains of pepsine 
or pancreatine with each meal. 
CHLOROSIS. 

Green Sickness — Is a peculiar form of anaemia 
affecting young women about the period of puber- 
ty. The skin, lips and gums are very pale ; a 
pure white in blondes, and a greenish or yellow- 
ish waxy appearance in those of dark com- 
plexion. The paleness of the skin is often best 
seen in the ears, which look like pure white wax. 
The fat under the skin is normal in amount or even 
increased, and there is no great tendency to watery 
swellings (oedema). Hence, moderate paleness of 
the surface and swelling of the feet show anaemia 
and not chlorosis. The red corpuscles of the 
blood, which are the carriers of oxygen from the 
lungs, are reduced to one-half of their proper 
number or less; hence, there is shortness of 
breath, which is increased by exertion, because it 
increases the formation of carbonic acid and 
causes hurried breathing to get rid of it and to 



Green Sickness. 157 

supply oxygen. For the same reason there are 
cold hands and feet, chilliness of the body and 
even cold breath, because enough food or tissue 
cannot be burnt in the body to supply sufficient 
animal heat, owing to the difficulty in supplying 
oxygen and getting rid of the carbonic acid 
formed. Our bodies are slow combustion stoves, 
which burn food with the same result as an ordin- 
ary fire, viz., they produce carbonic acid and 
water-vapor with some half-burnt food (urea, uric 
acid, etc.), comparable to cinders, and from the 
same amount of food or fuel they extract equal 
quantities of heat ; hence, the reason why dimin- 
ished oxidation (food may be taken into the body 
and not used) causes coldness of the extremities, 
etc., and, also, why a man doing hard work or 
exposed to severe cold requires more food, especi- 
ally fat. In chlorosis, the patient is weak, languid 
and easily fatigued [see Fig. 19]. She suffers from 
false rheumatic pains and excessive nervous irrita- 
bility, neuralgia, a disposition to weep, etc., from 
deficient oxygenation of the blood. There is ex- 
cessive sensibility of the skin, the appetite is de- 
ficient or depraved, the pulse soft, slow and feeble, 
urine abundant and light-colored, and the monthly 
flow absent or disordered. There is a humming 
sound in the veins, and she suffers from palpita- 
tion. Chlorosis is never dangerous in itself, but 
it is apt to be accompanied by chronic ulcer of 
the stomach. 




Fig. 19.— Chlorosis. 



Dropsy. 159 

Treatment — Change of air ; good food ; bath- 
ing ; milk and one-quarter of lime water ; beef- 
tea; soups; quinine, 2 grains daily. I depend 
chiefly on iron in some form, say 3 to 5 grains 
of the sulphate, thrice a day, with an equal weight 
of carbonate of potash, after food. 

ANASARCA. 

Dropsy — Is an accumulation of watery fluid in 
the meshes of the tissue below the skin ; it usually 
begins in the feet and ankles or beneath the eyes. 
It pits on pressure, that is, retains a depression for 
some time after the finger is removed, and is 
usually associated with bloodlessness. The treat- 
ment is according to the cause. Iron, alteratives, 
tapping, or consult personally some physician, a 
graduate of any standard college of medicine and 
surgery. 

BERI-BERI. 

Is a very fatal disease common in many parts 
of India, and begins by bloodlessness and stiff- 
ness, numbness, or even paralysis, of the lower 
limbs. There is weakness, palpitation and breath- 
lessness on exertion, cold extremities, costive 
bowels, and general dropsy. A residence of sev- 
eral months in a district where it prevails is 
necessary to its development. 

Treatment. — Stimulants; good diet; tonics — 
quinine 2 grains, daily ; turpentine, 4 drops, may 
be needed twice daily. 



LECTUEE V. 

Inflammation of the Brain and Membranes, or Encephali- 
tis.— Inflammation of the Membranes, or Meningitis.— 
Acute Hydrocephalus. — Inflammation, Softening and 
Abscess of the Brain.— Sunstroke. — Chronic Hydroceph- 
alus, or Water on the Brain. — Hypertrophy, Atrophy, 
and Tumors of the Brain.— Apoplexy. Diseases op the 
Spinal Cord —Inflammation of the Membranes of the 
Cord.— Inflammation of the Spinal Cord.— Spinal Hem- 
orrhage. — Spina Bifida (in infants). Diseases op the 
Nerves— Paralysis, or Palsy.— Paraplegia.— Paralytic 
Stroke, or Hemiplegia. — Locomotor Ataxy. —Wasting 
Palsy. — Infantile Paralysis. — Facial Paralysis. — Shak- 
ing Palsy. — Writers 1 Cramp.— Glosso-laryngeal Paral- 
ysis. — Cramp, or Spasms. — Child-Crowing. — Chorea. 
Functional Diseases op Nervous System — Tetanus, 
or Lock-jaw. — Epilepsy.— Hysteria.— Neuralgia.— Tic- 
douloureux. — Megrims.— Sciatica.— Intercostal Neu- 
ralgia. — Irritable Breast. Disorders op Intellect— 
Mania. — Melancholia.— Dementia.— General Paralysis 
of the Insane. 



ZjOCAX. diseases 

COMPREHEND all those which affect the 
structures of special organs or particular 
parts of the body ; they are often accompa- 
nied by constitutional symptoms which are sec- 
ondary to them ; thus, inflammation of the lungs 
is attended by fever, and often bears a close 
resemblance to typhoid fever ; on the other hand, 
general diseases have sometimes very striking 
local effects, as ulceration of the bowels in 



Nervous Diseases. 161 

typhoid fever. The nature of the disease is as- 
certained by finding which began first, the con- 
stitutional or local affection. 

DISEASES OF THE NERVOUS SYSTEM. 

The nervous system consists of two parts : first, 
the brain and spinal cord with the nerves pro- 
ceeding from and to them, which include all the 
nervous organs in and through which the mind 
acts directly ; and secondly, the sympathetic sys- 
tem of nerves and nerve-centres, which supply 
nervous energy for the continuous involuntary 
movements in health, such as the movements of 
the heart, stomach, bowels, and secreting glands 
of the body, as well as preserving the tone of the 
blood-vessels. The mind has an indirect influence 
on the organs supplied by the sympathetic sys- 
tem ; thus we can not blush nor shed tears at will, 
but suitable mental feelings cause these con- 
ditions. 

The brain alone furnishes the conditions neces- 
sary for intelligence, the spinal cord the con- 
ditions necessary for combined movements, 
except the movements of the face, tongue, and 
jaw, and together they connect the balance and 
regulation of motor and sensory power. The 
nerves consist of a number of fibres bound up in 
a sheath, and are of five different kinds: 1st, 
nerves of special sensation, comprising smell, 
sight, hearing and taste ; 2d, nerves of common 

11 



162 Dr. J. Keren's Lectures. 

sensation, and 3d, nerves of motion; 4th, mixed 
nerves of motion and sensation ; 5th, the sympa- 
thetic system of nerves. All nerves are endowed 
with the vital property of sensibility, in virtue 
of which they can be excited by chemical, me- 
chanical, or electrical stimulants, or by heat, to 
convey the influence of the impressions they 
receive from or to the brain, spinal cord or nerv- 
ous centres. Nerve-fibres possess no power of 
originating impulses; they require to be stim- 
ulated, and each fibre conveys the impression 
made on it separately without imparting or dif- 
fusing it, acting merely as a conductor. Nerve- 
fibres convey only one kind of impressions, those 
of sensation toward the brain or nerve-centres, or 
those of motion from the brain or nerve-centres, 
while mixed nerves consist of both classes of 
fibres, and convey in both directions. 

Whatever be the stimulus applied, whether 
mechanical, chemical, electrical, or heat, the 
kind of sensation transmitted remains the same; 
hence irritation of the optic nerve, as by a violent 
blow, causes flashes of light, of the auditory nerves 
causes singing in the ears, and so with the rest. 

When an impression is made on the trunk of a 
sensitive nerve the mind may perceive it, not only 
at the place where it was made, but also at all 
the points where the irritated fibres are distributed. 
Thus, if the ulnar nerve be compressed at the 
elbow (often called the funny-bone), the sensation 



Nervous Diseases. 163 

of pins and needles is felt in the palm and back 
of the hand, and in the fifth and half the fourth 
finger. In like manner, after amputation of a 
leg the patient may complain of pain in the toes, 
or cramp in the calf, from irritation of the fibres 
which formerly supplied those parts. From this 
reason patients who have had an amputation 
under chloroform not unfrequently refuse to 
believe the limb is off till they see the stump. 

The habit of the mind to refer impressions to 
the part which the nerve used to supply, is seen 
in making an artificial nose from the skin of the 
forehead; so long as the connecting bridge of 
skin to the forehead remains uncut, a touch on 
the nose feels as if it were made on the fore- 
head. 

The speed of the nerve current has been found 
to be about ninety feet a second, or at the rate of 
a lightning express train. The mind requires 
about one-sixteenth of a second to exercise sensa- 
tion and volition when the signal is by touch; 
about one-thirteenth of a second when the signal 
is by sight, and about one-seventh of a second 
when by hearing. Sensations may be defined as 
the consciousness of an impression, and that it 
may take place it is necessary (1) that a stimulus 
be applied to a nerve of sensation; (2) that in- 
consequence of this an influence should be gen- 
erated and conducted along the nerve to the 
brain; (3) consciousness of the influence. Sen- 



164 Dr. J. Kean's Lectures. 

sation may be lost by anything which destroys or 
hinders the sensibility of the nerve, as cold to 
the skin in frost-bite ; or its conducting power, as 
compression or severing of the nerve or spinal 
cord, by which communication with the brain is 
cut off ; and, finally, by the mind being excited, 
inattentive, or suspended — a common example 
being the use of chloroform, producing uncon- 
sciousness. Motion is accomplished through the 
muscles, which are endowed with the vital prop- 
erty of contractility, as nerves are with sensibility. 
Contractility may be excited independently of 
the nerves by various stimulants, but may also be 
excited by physical or mental stimuli operating 
through the nerves. Integrity of the muscle 
alone is needed for contractile movements, but 
there must also be integrity of the spinal cord 
for reflex movements, and also of the brain for 
voluntary movements. In healthy people the 
nerves of motion receive a part of their stimulus 
or excitement from the will producing voluntary 
motion ; and from parts of the brain, which, when 
excited, are independent of the will, such as the 
movements in anger, grief, or pain ; and actions 
produced without the will, or even against it, and 
which are independent of consciousness, in many 
•cases going on after an animal is decapitated. 
They are produced by impressions conveyed by 
a sensory nerve to a nerve-centre, from which it 
is returned or reflected, as a motor influence along 



Nervous Diseases. 165 

a motor nerve, causing movements which are 
hence called reflex movements. 

For reflex action three things are necessary: 
(1) one or more sensory nerve-fibres to convey an 
impression to the nerve-centre ; (2) a nervous cen- 
tre to reflect the impression by a motor nerve. 
The spinal cord is the nerve-centre for all mus- 
cles of any size in the body; (3) one or more 
motor nerve-fibres to conduct the impression to 
the contracting tissue. 

All reflex actions are essentially involuntary, 
though they may be modified, controlled or pre- 
vented by a voluntary effort. In health all reflex 
actions have a distinct purpose, to secure the 
wellbeing of the body, but in disease the} r may 
be irregular and purposeless. Examples of the 
first are seen in breathing, the action of the 
bowels, and deglutition, while the purposeless 
movements of disease are seen in epilepsy, chorea, 
(St. Vitus dance), and tetanus, (lock-jaw). When 
reflex movements regularly recur by a moderate 
stimulus, they are called automatic, as in swal- 
lowing, where the contact of the food with the 
sensory nerves of the throat is the stimulus, or in 
breathing, where the excitant is the carbonic acid 
in the blood, or sucking in infants, where the 
stimulus is touching the lips. Many complex 
actions acquired at one time afterwards become 
automatic, such as walking, singing, playing on 
musical instruments, and the like. Reflex actions, 



166 Dr. J. KearCs Lectures. 

which are also more or less voluntary, are 
coughing, yawning, sneezing, sobbing, laughing, 
crying and hiccough. Actions which occur quite 
independently of consciousness are the move- 
ments of the bowels, heart, movements of the feet 
on tickling the soles, vomiting, winking on ap- 
proach of a body to the eye, closure of the wind- 
pipe when swallowing, and similar actions. Re- 
flex movements are sometimes increased by des- 
troying the connection of the organ with the 
brain; thus, on dividing the pneumogastric 
nerve, the heart beats quicker, from the sympa- 
thetic ganglia or nerve-centres of the heart being 
no longer restrained by the action of the brain, 
and in paralysis of the nether limbs from a 
broken back the patient sees them kick when the 
soles of the feet are tickled, but he feels nothing, 
and cannot restrain this physical motion. 

All the functions of the nervous system may be 
increased, perverted, or destroyed, according to 
the degree of stimulus or disease acting on the 
Various parts; a slight excitant usually increases 
the action, a stronger stimulus, or longer continu- 
ance of the same perverts nervous action, while 
a still stronger exciting influence destroys it. 
The seat of the disease, and the rapidity or slow- 
ness of its occurrence, influence the symptoms; 
thus, disease of one side of the brain paralyzes 
the other side of the body, and as a rule a 
small injury, as an effusion of blood, occurring 



Nervous Diseases. 16? 

suddenly, and with force, produces more violent 
effects than an extensive disease which appears 
slowly. Whatever the nature of the injury, if 
the same part of the brain be affected, the symp- 
toms are much the same. 

Excitement of a nerve of motion is shown by 
contraction of the muscle it supplies, in the same 
way that irritation of a nerve of sensation is 
demonstrated by pain or reflex action. If a 
nerve of motion be agitated a second time before 
the contraction of the muscle from the first 
excitement has died away, a permanent state of 
muscular contraction is produced, which is called 
tonic spasms. If the interval between two excite 
ments is longer, so the muscle has time to relax 
between the contractions, it is called clonic 
spasms, both of which are seen in tetanus and 
strychnine poisoning. The terms cramp and 
spasm are applied to certain morbid conditions, 
in which an irritant of unusual origin, independ- 
ently of the will, directly disturbs the motor 
nerves, or where an ordinary stimulant causes 
violent excitement. 

The sympathetic system consists of a number 
of ganglia, or nerve-centres, connected to each 
other, and to the nerves of the brain and spinal 
cord, by a number of connecting filaments. 
They influence the general processes of involun- 
tary motion, secretion, and nutrition, and the 
parts supplied by them are usually incapable of 



168 Dr. J. Kean's Lectures. 

voluntary movement. The parts supplied with 
motor power from a sympathetic ganglion 
continue to move, though cut off from connection 
with the rest of the nervous system ; for example, 
the heart of some reptiles continues to beat for 
hours after being removed from the body. Move- 
ments caused by irritating a motor nerve which 
does not pass through a ganglion are convulsive 
and disorderly, while if it passes through a gang- 
lion the motions are orderly, and like natural 
movements. In health the mind is not conscious 
of the motions caused by the sympathetic system, 
but in disease it may communicate the sensation 
of severe pain to the spinal nerve, and thence to 
the brain, as in angina pectoris and cholic. 
When the sympathetic system is irritated, as in 
the first stage of fevers, it causes contraction of 
the blood-vessels, hence the chilliness and cold 
pale surface; but as the fever becomes more 
intense the sympathetic system becomes par- 
alyzed, allowing the blood-vessels to extend to 
their full size, causing heat. The same result 
also takes place in inflammation. 

In disease all exaggeration or perversion of 
sensation, motion, body heat, special senses, 
especially that of the eye, and mental faculties 
require to be noticed, as all give more or less val- 
uable warnings of disease, and means of judging 
as to its course. A general rule of treatment, 
applicable to all diseases of the nervous system, is 



Diseases of the Brain. 169 

to keep the head cool, the feet warm, and the bowels 
regular. [See G. B., published separately.] 

The brain is the seat of the injury or disease 
when intelligence or several special senses are 
affected together ; when the muscles of the face 
and tongue are involved, and the eyelids can still 
be closed ; or when there is paralysis of one side 
of the body only — for example, insanity, apoplexy, 
somnambulism. 

The spinal cord is the seat of the disease or 
injury when both sides of the body are affected 
and the mental powers remain unchanged — for 
example, lock-jaw, chorea, hydrophobia. 

Both the brain and spinal cord are affected in 
epilepsy and catalepsy. 

The nerve trunks are the seat of the affection 
when the symptoms are referable to a single 
group of muscles or a small portion of the skin 
— for example, neuralgia and local paralysis. 

DISEASES OF THE BKAIN AND 
ITS MEMBRANES. 

The general treatment of diseases and injuries 
of the brain is directed to keeping down the 
blood pressure in the head, which is accom- 
plished by cold to the head, purgatives, which 
draw blood to the bowels, warmth to the feet, and 
mustard poultices to the calves or abdomen, 
which draw the blood to them. 



170 Dr. J. KearVs Lectures. 

ENCEPHALITIS 

(Inflammation of the Brain and Membranes) 

Is a rare disease, and may arise from morbid 
poisons, as of fevers; from injuries, intemper- 
ance, death of some bone of the skull, or natural 
decay. It occurs at all ages. There is some heat 
of the head and surface. The face is pale, the 
pulse slow and irregular, the breathing variable 
and sighing. There is acute headache which 
does not abate when the fever subsides, as it does 
in twelve to twenty-four hours, with constipation, 
sickness and vomiting. The patient has a look 
of oppression or sullenness, suffused eyes, con- 
fusion of thought or even delirium, and con- 
tracted pupil. After from twelve hours to two 
days the second stage sets in, with difficult or 
indistinct articulation, dull vision and hearing, 
twitchings of the muscles, pupil contracted to 
the size of a pin's point, convulsive paroxysms, 
paralysis, and profound sleep (coma), which usu- 
ally ends in death. 

Treatment. — Cooling lotions to the head. 
Take 

Tincture of aconite 40 drops. 

Fluid extract of gelsemium 10 drops. 

Water 4 oz. 

Mix. 

Dose — One teaspoonful thrice daily in water, 
and apply the following to throat, temples, and 
back of the neck : 



Meningitis. 171 

Take 

Spirits of turpentine % oz. 

Olive oil 2 oz. 

Mix. 

Milk diet, and rest with the head elevated 
above the shoulders. 

MENINGITIS 

(Inflammation of the Brain Membranes) 

May arise from one of the specific fevers or 
rheumatism, gout, syphilis (see G. B. published 
separately), inflammation of the lungs, Bright's 
disease, protracted diarrhoea, or without appar- 
ent cause. Premonitory symptoms may be tri- 
fling or absent ; the most common are slight but 
increasing pain of the head, irritable temper, 
restlessness, chills, and pale skin; in children, 
convulsions followed by fever, irregular sighing 
breathing, often with moaning. % If the pulse falls 
from 140 or 120 to 80 or 60, while the fever and 
other symptoms increase, it is almost certainly 
meningitis. The skin will get hot and dry, the 
pulse hard and rapid, the bowels are obstinately 
constipated, and the stools are dark and offensive. 
In this stage there is little or no prostration of 
strength, the headache becomes acute with in- 
tense pain, the eyeballs stare and are injected, 
the face flushes and turns pale alternately. The 
temper is very irritable, and there is marked 
drowsiness or wakefulness, alternating frequently 



172 



Dr. J. Keart's Lectures. 



for several days. Noisy, violent delirium appears 
early, the patient screaming and gesticulating in 
the wildest manner; the expression of counte- 
nance is savage, fierce or malignant. The sharp, 
darting pain of the headache elicits a piercing 
cry, especially in children, who cany the head in 
their hands. The pain is increased by the im- 
pressions of the senses ; hence the eyes [see Fig. 
20] are kept obstinately closed, and the ears if 




Fig. 20.— Meningitis. 



possible covered with the bed-clothes. Restless- 
ness is incessant, with muscular twitchings and 
squinting, or rolling of the eye-balls. Vomiting 
is frequent without pain, tenderness, or sickness. 
This stage continues from one to four days. 



Acute Hydrocephalus. 173 

In the second stage the fever lessens, the pulse 
is slower, weaker, and varies very much in a 
short space of time ; breathing is very irregular, 
the tongue is brown and dry, the bowels continue 
confined, the heat of the head continues, but the 
body is cool and excitement diminishes. The 
delirium is apt to pass into coma (deadly sleep), 
and there is great prostration. When the disease 
ends favorably, improvement is very gradual. 

In meningitis of the aged there are few symp- 
toms beyond peevish or irritable temper and 
confusion of intellect, with restlessness and un- 
steady gait. 

Treatment is according to the cause. Generally 
20 grains compound j alap powder to get motion 
of the bowels, repeated if necessary. The head 
should be raised and lotions applied to the 
(shaved) scalp by cloths saturated with the fol- 
lowing : 
Take 

Muriate of ammonia 1 oz. 

Solid extract of belladonna % oz. 

Boiling water. 1 pint. 

Mix. 

And take fluid extract of gelsemium in 1 drop 
doses in water twice daily. Milk diet, rest in a 
quiet darkened room. 

ACUTE HYDROCEPHALUS. 

(Dropsy of the Brain) 

Occurs chiefly in children between the ages of 



174 Dr. J. Ream's Lectures. 

two and four. It is rarely found during the first 
year of life or after the twelfth. When it occurs 
in adults, it is almost always associated with con- 
sumption of the lungs. 

Scrofulous children with large heads and pre- 
cocious intellects, and especially the children of 
parents addicted to drunkenness, are the most 
frequent victims. The symptoms may be divided 
into three stages. 

1st Stage. — The child shows a change of man- 
ner and has no desire to play, but sits in a corner 
resting the head on the hands. It complains of 
pain in the head, and is drowsy yet restless. 
There is loss of flesh and feverishness, with con- 
stipated bowels, sunken abdomen, and vomiting, 
especially when disturbed or made to stand. 

2d Stage. — After some days, or even weeks, 
more prominent symptoms appear. The child 
complains more of the head, turns from the light 
and starts at every sound, it gnashes its teeth 
during sleep and occasionally gives a piercing 
cry; it often starts with terror at some dream, 
and continues terrified for some time after 
waking. The head is hot and bent back, boring 
into the pillows, the lymphatic glands of the 
neck swollen, the muscles of the back of the neck 
contracted, and there are twitchings of the limbs. 
At this stage the pupils ot the eyes are contracted, 
and the pulse rapid. After four or five days there 
is a change of symptoms. 



Acute Hydrocephalus. 175 

3d Stage. — Often marked by general convul- 
sions. The vomiting abates or ceases, the face is 
alternately flushed and pale, the eyes closed, and 
the eyebrows knit; the child no longer complains 
of pain, but places its hands to its head in a pecu- 
liar way. It wishes to be left quiet, but does not 
turn away from the light nor start at a noise as it 
did formerly. The peculiar cry and gnashing of 
the teeth continue, the pupils become dilated, and 
the eyes squint and no longer regard objects held 
in front of them. The pulse becomes slower, 
falling to 60 or less, and the breathing is pecu- 
liar, several slight breaths being succeeded by a 
deep sighing inspiration, followed by stupor 
(coma), which gradually increases, the lucid 
intervals grow shorter and less complete, the eyes 
stare into space, or the upper eyelid droops and 
the eyeball is rolled up so that the pupil is half 
covered by the eyelid, the cheeks often become 
bright, and the eyes when visible are dark and 
brilliant from the dilated pupil, or the face may 
be dark- colored and pinched, with the eyes 
sunken. The child lies insensible, picking its 
nose and lips with trembling fingers, and may 
have fits of convulsions or paralysis. There are 
often deceitful remissions which last for a short 
time. After about a week in fatal cases, twelve 
or twenty-four hours before death, the pulse gets 
quick and feeble, the skiD is covered with cold 
perspiration, the abdomen becomes puffed up, 



176 Dr. J. K earl's Lectures. 

and the stools and urine are passed involun- 
tarily. 

TREATMENT. 

Take- 
Tincture of aconite 40 drops. 

Tincture of gelsemium 20 drops. 

Water 4 oz. 

Mix. 

Dose — One teaspoonful in a half-wineglass of 
water three times daily, and apply to the throat 
the following : 

Take 

Oil of turpentine -3^ oz. 

Olive oil 2 oz. 

Mix. 

Iodide of potassium 2 grains three times a day, 
with milk diet. It is of great importance to 
recognize the disease early, and begin proper 
treatment at once. Though a very fatal and 
treacherous disease, life is not always to be 
despaired of, even when well advanced. I have 
had recovery of a child after being insensible 
more or less for three weeks, by persistent use of 
above treatment combined with iodide of potas- 
sium, free action of the bowels, and milk diet. In 
event of recovery, when there is an hereditary 
tendency, as in children whose brothers or sisters 
died of acute hydrocephalus, cream should be 
given for a considerable time, say a month, two or 
three times every year till twelve years old. 

Spurious Hydrocephalus — Children from a few 
months to three years old, who have had diarrhoea 
or been severely purged by medicine, or who have 



Spurious Hydrocephalus. 177 

ceased to thrive after being weaned, having green 
stools, are apt to have a false appearance of hy- 
drocephalus. The child lies on its nurse's lap 
unable or unwilling to raise its head. It seems 
half asleep, one moment opening its eyes, and the 
next closing them again with a remarkable ex- 
pression of languor ; the eyes are not attracted by 
any object in front of them, and the pupil remains 
unmoved on the approach of light. The breath- 
ing is irregular, sometimes sighing, and the voice 
is husky. The tongue is slightly white, and the 
skin is not hot, but, at times, colder than natural. 
This disease has been mistaken for hydrocephalus, 
and the child destroyed by improper treatment. 
To distinguish them, notice if the unclosed por- 
tion at the top of the skull (fontanelle) is convex 
and prominent; if it is, the disease is probably 
hydrocephalus, and you may expect benefit from 
proper remedies ; but if it is concave and sunken, 
it proceeds from emptiness and want of support, 
and the child requires nourishment, brandy in 
arrowroot, milk (from the mother's breast, if pos- 
sible), or cream and an equal amount of water. 

CHRONIC HYDROCEPHALUS 
(Chronic Dropsy of the Brain) 
Is an entirely different disease from acute hydro- 
cephalus. It begins at birth or soon after in scrof- 
ulous or rickety children ; the bones of the skull 
become enlarged, light, thin and chalky, and the 

12 



178 Dr. J. K earl's Lectures. 

head may attain to an enormous size, even up to 
two feet in diameter, and containing many pints 
of fluid ; not unfrequently a part of the brain sub- 
stance is broken down by the fluid into a white 
pulp, constituting white softening. 

The disease usually shows itself in the first six 
months of life. The child takes food eagerly, but 
does not seem to thrive ; the body becomes wasted 
and the little face, which does not agree with the 
large skull, forms a triangle with the head, the 
point being at the chin, and the forehead is prom- 
inent. The child is generally of feeble intellect, 
irritable temper, great muscular debility, and 
often liable to epileptic fits. It has great diffi- 
culty in holding up its head, and often there is 
rolling or squinting of the eyes. The symptoms 
may continue increasing to stupor, paralysis and 
death ; or, after reaching a certain point, it may 
discontinue and remain permanent, or even 
slightly improve. 

Treatment. — Milk diet, iodide of potassium, 
% grain twice a day. The head should be kept 
covered with flannel. 

INFLAMMATION OF THE BRAIN. 

Inflammation of the brain substance alone is a 
rare occurrence, and is limited to one part of the 
brain. It may arise from long suppuration from 
the ears, specific fevers or external injuries. The 
symptoms show cerebral irritation more promi- 



Inflammation of the Brain. 179 

nent one time in the sensory, another time in the 
motor or mental functions. 

In the Sensory. — Violent headache, intoler- 
ance of light, and increased sensitiveness of all 
the special senses. The motor symptoms consist 
of restlessness, sudden starting, vomiting, gnash- 
ing the teeth, crying out, twitching of single 
muscles, and convulsions. The mental symptoms 
are confusion of ideas with loss of memory and 
delirium, in which he has hallucinations and 
illusions. Instead of irritation there may be 
cerebral depression, in which sight and hearing 
are impaired, and all the senses are less active. 

Treatment. — Same as Encephalitis. » 

SOFTENING OF THE BRAIN 
Is usually partial, the size of a walnut to a hen's 
egg\ chronic, and due to obstructed circulation. 
When small it may heal, leaving a cyst filled with 
serous fluid. The symptoms are usually acute, 
but there are none for a considerable time. 
There are three different kinds of softening : 

1. White, which is death of a portion of 
brain substance from impaired nutrition, gener- 
ally due to disease of the large arteries (atheroma). 

2. Red and inflammatory softening, which is 
due to the closure of some artery by a clot of 
blood or film, or may be at the last stage of 
acute hydrocephalus. 

3. Yellow softeDing, which is a fatty degener- 



180 Dr. J. KearVs Lectures. 

ation of a portion of brain substance, due to the 
obstruction of an artery at the base of the brain. 
It has no tendency to cure, and is generally fatal 
in a few days. The attack is like apoplexy, and 
is often without premonitory symptoms. 

ABSCESS OF THE BRAIN 
Is generally caused by inflammation of the inter- 
nal ear after scarlet fever, measles, small-pox, or 
scrofula. The symptoms are obscure; those 
which attract attention are usually sudden head- 
ache, fever and vomiting. The patient is sullen, 
and may be delirious, with contracted pupils, and 
shuns the light. It is recognized during life only 
by experienced physicians. 

Treatment. — Rest and quiet, regular action of 
the bowels, milk diet, and iodide of potassium, 2 
grains twice a day. The duration of abscess is 
variable, from three weeks to three months. 

The premonitory symptoms are pain in the 
head, more or less severe, sudden and short 
attacks of giddiness, diminished mental power, 
depression of spirits, prickings and twitch ings, a 
pain and numbness in the limbs, drowsiness, es- 
pecially after meals, impairment of sight and 
hearing. In red softening, headache, cramps and 
transient excitement, or mild delirium, precede 
the loss of perception. The patient lies still as 
if in profound sleep, but immediately gives the 
hand or protrudes the tongue, if told to do so, 



Abscess of the Brain. 181 

intelligence remaining intact. The loss of percep- 
tion and volition, however, is not recovered from. 
Paralysis of a limb or one-half of the body may 
appear suddenly without loss of consciousness. 
The patient is easily confused, and has a diffi- 
culty in answering questions and in making him- 




Fig. 21— Abscess of the Bbaix. 

self understood. The muscles of the tace are 
more or less paralyzed on one side [see Fig. 21], 
speech is impaired, and after slight recovery con- 
tinues so. The pulse is weak and intermitting, 
vomiting and constipation occur in some, involun- 
tary escape of stools, difficult breathing, becoming 
snoring, and stupor, precede death. The symp- 
toms vary considerably ; the following may occur 




Pig. 22.— Coup de Soleil (Sunstroke). 



Sunstroke. 183 

in different cases: 1. Imperfect stupor, partial 
loss of consciousness with rigidity of the limbs ; 
2. Perfect stupor, without rigidity ; 3. Paralysis 
without loss of consciousness ; 4. Paralysis with 
increased sensitiveness of skin ; 5. Rigidity com- 
ing on after return of consciousness. Softening 
and abscess are not so common as apoplexy or 
meningitis. 

The after-effects differ from apoplexy. The 
symptoms do not suddenly disappear or improve 
gradually, but the mental enfeeblement and 
paralysis usually remain. 

Preventive Treatment. — Rest, lying down 
with the head elevated ; in severe seizures an in- 
jection of castor-oil and turpentine, a tablespoon- 
ful of each ; if consciousness is not lost. 

Take 

Compound jalap powder 20 grains 

instead of the injection; hot bottles to the feet. 
If the head is hot, apply cold lotion ; if the eyes 
are suffused and the face red, leeches behind the 
ears may be required ; milk diet. For pains in 
the limbs, morphia, one-sixth of a grain at bed- 
time. 

COUP DE SOLEIL 
(sunstroke) 
Is a disease allied to apoplexy, and is charac- 
terized by giddiness, faintness, thirst, at times 
headache, listlessness and torpor, with a desire 



184 Dr. J. Kea?i\s Lectures. 

to lie down, succeeded by more or less sud- 
den and complete insensibility ; the skin is hot 
and dry, the breathing rapid, the pupils contract- 
ed, the face pale, and an attack of vomiting or 
convulsions may usher in complete stupor. Just 
before death the pulse becomes fluttering, the 
breathing irregular and gasping, and the pupils 
dilated. Death may occur from five minutes to a 
few hours after the symptoms have set in. The 
patient is not free from danger till the skin is cool 
and moist again. After recovery from the first 
symptoms, there is a great tendency to paralysis 
or various forms of insanity, so that his faculties 
are seriously impaired. Generally, the affection 
seems induced lay fatigue or nervous exhaustion 
in a hot, dry atmosphere, and want of perspiration 
from not drinking enough. The attack is most 
common during exposure to the rays of the sun, 
but in hot climates it may occur during the 
night. 

Treatment. — Kemove the clothes and dip the 
patient in the nearest stream, [See Fig. 22,] or 
throw a spray over the head and chest. 

The good effect of the treatment is shown by the 
pupils relaxing. Cut the hair short and apply 
cold lotions to the scalp, mustard poultices to the 
calves and over the abdomen for ten to fifteen 
minutes, and to the nape of the neck apply turpen- 
tine and oil, 



Enlargement of the Brain. 185 

HYPERTROPHY OF THE BRAIN 

(Enlargement of the Brain) 
Is most common in childhood and in dwarfs. 
It consists of hypertrophy of the connective or 
packing tissue material and not the brain sub- 
stance. The skull is enlarged, and the child 
may sutler from paralysis, convulsions, and other 
symptoms of irritation. Sometimes the child is 
smart instead of being deficient in intellect, as 
in hydrocephalus. The course of the disease is 
always chronic. There is no remedy which has 
any effect on the disease. 

ATROPHY (DIMINUTION) OF THE BRAIN 
May be either incomplete development, or retro- 
gression. There is usually weakness of intellect 
or decided idiocy; the senses are blunted, and 
there may be paralysis and wasting of one side 
of the bod3 T with epileptic attacks. The speech 
is impaired, and the gait uncertain and tottering. 

TUMORS IN THE BRAIN 
May be simple, cancerous, tubercular, glandular, 
fatty or cystic, aneurisms, or from syphilis. The 
symptoms vaiy according to the part affected; 
chronic headache and attacks of epilepsy are 
the most common. Syphilitic tumors (see G. B. 
published separately) are the only ones where 
treatment is of any avail. Both tumors and 
atrophy are rare. 



186 Dr. J. K can's Lectures. 

APOPLEXY 

(Pressure on the Brain) 
Is characterized by a state of stupor or profound 
insensibility, commencing suddenly, or at least 
rapidly, the patient manifesting signs of a deep 
sleep from which he cannot be roused. The pulse 
is slow and strong, or irregular, but labored, i. e., 
passes slowly under the finger ; the breathing is 
slow and labored, and accompanied by a snoring 
sound ; the cheeks are puffed out with each ex- 
piration like the napping of a sail. There is 
frothy saliva about the mouth ; fluids poured into 
the mouth are not swallowed, but cause choking 
or run out at the corners ; the limbs lie motion- 
less, and if one is raised, it falls again as if dead, 
and the pupils are contracted. In bad cases one 
or both pupils may be dilated, the teeth clenched, 
and some or all of the muscles rigid, with cold, 
clammy perspiration. After the seizure or fit 
has lasted from two hours to two or three days, 
the patient recovers consciousness, but one side 
of the body usually remains paralyzed. On the 
affected side the angle of the mouth hangs down, 
the nostril is contracted, and the cheek expands 
at each expiration. On the unaffected side the 
angle of the mouth is elevated and the nostril 
dilated ; the face is drawn to the sound side, and 
when the tongue is distended it is pushed to the 
affected side (see Facial Paralysis). The hand 
and foot cannot be moved except by lifting them 



Apoplexy. 



187 



by the hand of the unaffected side. These symp- 
toms may gradually improve, but the patient 
never becomes so strong as before. The pre- 
ceding are the symptoms of the most usual form 
of apoplexy, which is caused by rupture of a 
blood-vessel. There are three different kinds of 
apoplexy, the symptoms of which, during the fit, 
may be the same, but the after-effects differ. 

1. Hemorrhagic. When a diseased blood- 
vessel bursts and effuses blood into the brain — 




Fig. 23.— Apoplexy. 

which explains why it is more common after forty, 
from the vessels beginning to degenerate — or 
thrombosis (where a clot chokes an artery) of the 



188 Dr. J. KearCs Lectures. 

brain ; hence it is common in some kinds of heart 
disease. 

2. Congestive apoplexy. Where the symptoms 
seem due to pressure on the brain from increased 
pressure of the blood in the vessels. 

8. Serous apoplexy. Where the symptoms 
are due to effusion of serous fluid, most common 
in Bright's disease. 

The actual attack may occur in three ways : 

1st. The most usual is to come on suddenly [see 
Fig. 23], the patient falling to the ground at once, 
devoid of sensation and consciousness, or he may 
merely stagger and have time to sit down. From 
this state, if he does not die during the fit, the 
patient may recover, with paralysis of one side ; 
or completely, after an interval of confusion, 
where the symptoms are due to congestive or 
serous apoplexy. 

2d. The symptoms come on slowly, the patient 
complains of a sudden pain in the head, sickness, 
faintness, and at times vomiting. He may fall to 
the ground or have merely a slight transient loss 
of consciousness, but the pain in the head con- 
tinues, and after a few hours he becomes heavy, 
oppressed, forgetful and drowsy, gradually pass- 
ing into complete stupor, from which recover}^ is 
rare, the symptoms being due to rupture of a 
blood-vessel and blood slowly escaping. 

3d. There is an attack of paralysis of one side, 
but no loss of consciousness at first ; the paralysis 



Apoplexy. 



189 



gradually passes into stupor, or he may slowly 
recover. 

The blood effused into the brain may be 
absorbed, leaving a scar or a cyst filled with fluid ; 
in either case the brain is weakened and predis- 
posed to another attack. 

The seizure usually occurs during some muscu- 
lar exertion, such as pulling on a pair of boots, 
lifting a heavy weight, or even sudden change of 
position, as in stooping. 




Fig. 34.— Effusion ox the Brain. 

Apoplexy is more common in men than in 
women, and is rare before forty years of age, 
though it is found even in children [see Fig. 24]. 
It may occur quite unexpectedly, but usually 
there are premonitory warnings, extending over 



190 



Dr. J. Keari's Lectures. 



a variable period of a few minutes, patients often 
attempting to reach a place of safety [see Fig. 25]. 
It frequently extends to months. The warnings 
are giddiness, particularly on stooping, headache, 
and a feeling of weight and fullness in the heM, 
drowsiness, with heavy breathing, especially after 
meals, confusion of thought with occasional loss 
of memory, numbness in the limbs, disturbed 




Fig. 25.— Premonitory Warning. 
sleep, mental depression, indistinct speech, tem- 
porary paralysis of some muscles; there may be 
bleedings from the nose, temporary blindness or 
deafness, or noises in the ears and flashes before 
the eyes. / 

Certain persons are predisposed to an attack. 
Those whose parents suffered from it, and people 
of sedentary habits who eat and drink too much 



Apoplexy. 191 

are frequent victims. Long-continued mental anx- 
iety, violent emotions, intemperance, disease of 
the heart, kidneys, or blood-vessels of the brain, 
and sudden suppression of long-standing dis- 
charges, are all causes of apoplexy. 

Treatment. — During the fit : Loose the cloth- 
ing about the neck, raise the head above the 
body, remove the patient into a cool, well-venti- 
lated room, apply cold to the head by pounded 
ice. If the power of swallowing is not lost, give 
twenty grains of compound jalap powder; if 
it is lost, place two drops of croton oil on the 
back of the tongue. Apply mustard poultices to 
the calves and abdomen for ten minutes, and 
place hot bottles to the feet. In some cases, 
where there is a strong thrilling pulse, the blood- 
vessels'of the head and face congested, the scalp 
hot and the skin warm, the breathing slow and 
snoring, apply ligatures (any stout cord tied) 
round each limb close to the body ; but if the 
pulse be small, slow, feeble or irregular, the skin 
cold and clammy, if the patient has been intem- 
perate or suffered from disease of the heart, from 
gout or rheumatism, do not resort to ligatures, but 
give the following : 
Take 

Fluid extract of belladonna 1 drachm. 

Fluid extract of xanthoxylum frax- 
ineum 3 drachms. 

Water. . . 4 oz. 

Mix. 



192 Dr. J. Kearts Lectures. 

Dose — One teaspoonful, and repeat soon after if 
necessary. (See precautionary rules, Lecture 
XVII.) 

The diet should be limited to milk, light pud- 
dings and fish, till all danger of a relapse is over. 
In event of recovery great care is needed to pre- 
vent a second fit. The patient must avoid strong 
bodily exertion, violent passions and emotions, 
heavy meals, strong wines, hot baths, long-contin- 
ued stooping, tight neck-cloths, constipation and 
straining at stool, or any cause that favors the 
flow of blood to the head. He should take daily 
exercise in the open air and wash the head in 
cold water every morning. If there should be an 
attack of giddiness or bleeding from the nose, he 
should take a purgative such as compound jalap 
powder, 15 grains. 

DISEASES OF THE SPIRAL CORD 
AXD ITS MEMBRANES. 

SPINAL MENINGITIS. 
(Inflammation of the Membranes of 
the Cord.) 
Is not a common disease. It probably never 
occurs of itself, but from injury, disease of the 
bones (caries), exposure to wet or cold in rheu- 
matic people, syphilis (see G. B. published separ- 
ately), gout, or extension from the brain. 
There is high fever and sleeplessness, acute 



Inflammation, of the, Spinal Cord. 198 

burning pain in the back, extending into the 
limbs, which becomes unbearable on motion of 
the back or pressure over the spine. There is 
rigidity, or tetanic contraction of the muscles of 
the neck and back, occasionally interrupted by 
convulsive starts. There is feebleness of the 
limbs, and stiffness of the muscles, worse in the 
morning, after a night's rest, and which may go 
on to paralysis, and gradually extend upwards. 
There may be retention of urine, constipation, and 
a feeling of constriction in the neck, back and 
abdomen, with a feeling of suffocation. 

Treatment. — If it arises from injury, cold 
lotions to the spine; if not from injury, warm 
baths, leeches along the spine ; moderate purging 
by M to % an ounce of sulphate of magnesia, 
with tincture of hyoscyamus 40 drops. If there 
is severe pain along the spine, warm fomentations, 
containing tincture of hyoscyamus 2 drachms, to 
a teacupful of water may be used. When the 
acute symptoms subside, blisters on each side of 
the spine, and iodide of potassium 3 grains twice 
a day. 

MYELITIS 
(inflammation of the spinal cord) 
Is of rare occurrence and maybe excited by cold, 
damp, injuries, or extension from disease of the 
bones. It may terminate fatally, by inflamma- 
tion, softening or abscess. The symptoms vary 
according to the part affected. The first thing 

13 



194 Dr. J. KearVs Lectures. 

noticed is a feeling of cold and numbness in the 
fingers and toes, and extending up the limb, 
followed by pain in the back, which is not con- 
stant, but is increased by pressure over the affected 
part, or by application of a sponge filled with hot 
or cold water. These symptoms are succeeded by 
impaired motion, and often diminished sensation 
in one or more limbs, followed by palsy of both 
sides of the body. If only one side of the spinal 
cord is inflamed, only one side of the body is 
paralyzed. The paralysis is more extensive the 
higher up the seat of inflammation. Bed-sores 
are apt to form in chronic cases. 

Treatment. — Twenty grains compound jalap 
powder. Keep the bowels open three or four 
times a day. After the pain in the back is sub- 
dued, and paralysis appears, take of strychnine 
one-twenty-fourth of a grain, three times a day, 
till starting of the limbs during sleep is produced. 

SPINAL APOPLEXY 

(spinal hemorrhage) 
Is less frequent than apoplexy of the head ; is usu- 
ally the result of injuries, but may arise from in- 
flammation of the cord or its membranes, from 
fatty degeneration of the blood-vessels, or from 
disease of the bones (vertebrae). If the clot is 
large and high up, death may occur at once. The 
symptoms vary, and depend on the part of the 
cord affected. If the spinal cord is completely 



Spinal Haemorrhage. 195 

compressed above the third bone of the spinal 
column, instant death is the result from suspen- 
sion of breathing. If lower down, the general 
symptoms are loss of sensation and motion in all 
parts having nervous supply from below the in- 
jury. After a time, diminished temperature in 
the paralyzed parts, feeble circulation, and con- 
gestion of the lowest lying parts, a cadaverous 
hue of skin, and unhealthy bloodless appearance 
of the patient. 

When the clot or compression is at the lower 
end of the spinal column (lower lumbar) there is 
paralysis of sensation and motion of the lower 
limbs, and unconscious passage of stools and 
urine; or there may be retention of urine till the 
bladder is filled, and then a constant dribbling, 
owing to paralysis of the bladder and the sphinc- 
ter muscle of the bowel. The patient feels as if a 
cord was tied tightly round his body. 

When the compression is below the middle of 
the back (lower dorsal), there is, in addition, 
paralysis of the muscles of the abdomen, and 
distension of its walls, causing expiration to be 
less perfectly performed. When the compression 
is as high as nearly the level of the shoulders 
(third dorsal), sensation all over the trunk of the 
body is lost, except in front as far down as the 
level of the nipples ; breathing is peculiar from 
paralysis of the muscles of the ribs, and is almost 
entirely carried on by the diaphragm, or midrif ; 



196 Dr. J. Keari>8 Lectures. 

expiration especially is laborious; the patieDt 
can yawn, but cannot cough, nor sneeze. Defect- 
ive oxygenation of the blood gives rise to breath- 
lessness, and may cause congestive pneumonia. 

When the compression is as high as the fifth 
bone of the neck, in addition to all the other 
symptoms the arms are paralyzed and the patient 
presents the extraordinary appearance of a living 
head, with all its powers unimpaired, attached to 
a trunk and limbs of whose existence he is con- 
scious only by sight. 

Treatment is the same as for inflammation 
of the spinal cord. Disease of the bones may 
give many of the same symptoms, and may be 
relieved or cured by a surgeon of well-known 
skill and ability. Rest, and keeping the diseased 
bones apart by a case of bandage stiffened by 
plaster of paris. 

SPINA BIFIDA 

Is a disease in which a portion of the spinal 
canal is not closed at birth, leaving one or more 
tumors in the spinal column which communi- 
cate with the spinal canal. There is a soft 
swelling, covered with skin, or a membrane, like 
that which lines an egg, in the lower part of the 
child's back (lumbar region). At its base the 
edges of the bone may be felt, and the swelling 
is increased by crying or straining. The swell- 
ing usually increases rapidly, and the skin red- 



Paralysis. 197 

dens and becomes thin, and finally perforates, 
generally followed by convulsions, stupor and 
death. 

It is not necessarily fatal, but most children 
having spina bifida die before puberty. 

Treatment. — Protect the swelling by a piece 
of leather. Sometimes a cure can be effected by 
surgical interference of an experienced surgeon. 

DISEASES OF THE NEEYES. 
PARALYSIS 

(Palsy) 
Is usually restricted to loss of voluntary motion, 
and may be local, restricted to a part or muscle, 
or general when all the limbs are affected. Par- 
alysis of the nerves of sensation is called anaes- 
thesia. Paralysis may be due to some affection 
of the brain; to pressure upon or injury to a 
nerve; to hysteria; to the influence of poisons, 
such as lead. The palsied muscles may be little 
different from health, but less firm and less ex- 
citable by electricity; completely relaxed, soft, 
and rapidly wasting, and scarcely excited at all 
by galvanism ; contracted and rigid, the flexing 
muscles being always more rigid than the ex- 
tending, and generally associated with wasting; 
the muscles do not waste, but are constantly firm 
and rigid, the paralysis is not complete, and the 
excitability by electricity is increased. 



198 Dr. J. KeatJs Lectures. 

When the muscles are rigid chloroform is of 
service; in complete relaxation it is useless or 
hurtful. 

PARAPLEGIA. 

Paralysis affecting the lower half of the body- 
on both sides. It may be due to disease of the 
spinal cord and its membranes, or due to reflex 
action from a sensitive nerve, such as from the 
irritation of teething, or worms in children, from 
wounds, from affection of the womb, from urinary 
affections, or emotional paralysis. 

The symptoms usually begin slowly with weak- 
ness, numbness and tingling of the feet and nether 
limbs. The weakness increases till there is loss 
of sensation and motion in the inferior extremi- 
ties, paralysis of the bladder and sphincter mus- 
cle of the bowel, with involuntary movements and 
spasms of the lower limbs. 

Treatment. — In reflex paraplegia endeavor to 
remove the cause. One-thirtieth of a grain of 
strychnine and one grain of opium daily. When 
due to disease of the cord, a cold sponge causes a 
feeling of heat over the inflamed part, and a hot 
sponge a burning feeling. Apply a belladonna 
plaster over the spine, and iodide of potassium 
two grains daily. In both, nourishing diet and 
friction of the limbs. 



Pwralytie Stroke. 199 

HEMIPLEGIA 

(Paralytic Stroke) 

Is the most common form of paralysis, and affects 
only one side of the body, most commonly the 
left side. It indicates disease of the brain on the 
opposite side to that paralyzed. If only one 
limb is paralyzed, it is usually the arm. The 
paralysis may be complete, or some power of 
motion may be left. Consciousness may or may 
not be retained, but in either case the patient falls 
to the ground, because the balance of the body is 
destroyed. The affected arm and limb fall to the 
side as if lifeless, the leg resting on its outer side 
with the toes turned out. Tickling the sole of the 
paralyzed foot causes involuntary kicking or 
starting, by what is called reflex action, depend- 
ing on the spinal cord. 

The eye remains permanently open, the face is 
drawn to the unaffected side, and hangs down on 
the paralyzed side, food accumulates in the cheek, 
there is loss of power of masticating on that side, 
the tongue protrudes to the paralyzed side, speech 
is imperfect, and taste is lost in the front two- 
thirds of the tongue, which result from implica- 
tion of the seventh, fifth, and ninth cranial 
nerves. If the third nerve is also involved there 
is drooping of the upper eyelid, dilated pupil, 
which is insensible to light, and rolling outwards 
of the eyeball, and the eye constantly accommo- 



200 Dr. J. Kean'B Lectures. 

dated for long distances causing indistinct vision. 
Where swallowing is impaired there is serious 
and extensive injury to the brain. 

When paralysis is not so severe as to prevent 
walking, the attitude and gait are characteristic. 
The patient leans to the sound side, and the af- 
fected limb is swung outwards like a pendulum, 
with the toes pointing downwards as the foot 
leaves the ground, while the affected arm is car- 
ried by the opposite hand. 

Treatment. — Rest, lying down with the head 
raised, the mind kept tranquil, and free action of 
the bowels secured by podophyllin, colocynth, 
or leptandrin; afterwards exercise of the paral- 
yzed limbs by moving them, and rubbing with 
the hand or a flesh brush. After a lapse of two 
weeks time small doses of strychnia one-thirtieth 
of a grain twice a day after meals. 

LOCOMOTOR ATAXY 

Is a peculiar form of apparent paralysis, most 
common in men between thirty-five and fifty, and 
is caused by exposure to cold when fatigued, by 
sexual excesses (see G. B. published separately), 
rheumatism or gout. The course of the disease 
is always tedious, extending over years, and per- 
fect recovery is rare. 

The patient may have tearing pain in the lower 
limbs, which is generally considered rheumatic, 
for months, or even years, before the other symp- 



Locomotor Ataxy. 201 

toms appear. Persons who are accustomed to 
walking notice that they are sooner or more eas- 
ily fatigued than formerly ; these symptoms are 
succeeded after a time by a feeling of firmness, 
numbness, and a sensation as if a cord was tied 
round the middle, which may be accompanied or 
preceded by imperfect or double vision, squinting, 
contracted or dilated pupil and deafness. These 
affections generally appear at different times and 
singly, and after remaining some time may dis- 
appear. A distressing symptom in many cases 
is incontinence of urine; the patient cannot 
defer the call to urinate for more than a few 
seconds. There is occasional constipation, when 
the pains are severe, and it always aggravates 
them. Tickling sensations prevail in different 
parts of the body, and a feeling of numbness 
and of pins and needles in the legs, as if " asleep." 
After some time the gait becomes awkward and 
uncertain, the pains occur irregularly, and dart 
from limb to limb. There is diminished sensi- 
bility in the affected parts, the floor is no 
longer distinctly felt, the foot seems to rest on 
wool, soft sand, or a bladder filled with water. 
The muscular force is not diminished, but the 
power of regulating the movements gradually 
diminishes. If the patient does not also see his 
movements, the power of regulating them will be 
still more uncertain, so that he prefers remaining 
at home in the evening. The feet are lifted too 



202 Br. J. Kean's Lectures. 

high, and thrown forward and outward in quick, 
short, jerking steps, and strike the ground with 
the heel first, with a forcible stamp. If the 
patient stands with the heels together and closes 
his eyes, he begins to totter, and unless supported 
falls to the ground. As the disease progresses 
the limbs are thrown involuntarily to the right 
or left without power of control, and after a time 
walking becomes impossible even with the aid 
of a stick, although the muscular force remains 
good. Reflex actions do not take place on tick- 
ling the feet, and involuntary jerkings of the 
limbs take place during sleep. The same symp- 
toms come on at a later period in the arms, the 
lingers become numb and cannot button the 
clothes, when eating or drinking the contents of 
the spoon or glass are spilt, and combined move- 
ments such as writing, become impossible. There 
is no tenderness over the spine, and the intellect 
is in no way affected. 

Treatment. — Blister over the spine ; 30 drops 
of dilute phosphoric acid in water daily ; 4 table- 
spoonfuls of cream thrice daily ; nutritious food, 
and flannel worn next the skin. When the pain is 
severe, solid extract of belladonna, half a grain. 

PROGRESSIVE MUSCULAR ATROPHY 

(Wasting Palsy) 

Is not common, and is a fatty degeneration of the 

muscles, which is often hereditary, and attacks 

all ages, but men more frequently than women. 



Progressive Muscular Atrophy. 203 

The onset of the disease is slow, and it 
approaches unawares, usually beginning in the 
ball of the thumb or in the muscles of the shoulders. 
The patient notices a loss of power and awkward- 
ness in the affected limb, the weakness continues 
increasing till the grasp and lifting power 
are lost. Muscular twitchings or quiverings of 
the fibres of the affected muscles occur uncon- 
sciously. The bulk of the affected parts may be 
increased, sometimes enormously so. A child 
may have the lower limbs very large from depo- 
sition of fat among the muscles, and yet be 
unable to walk, the apparent increase of muscle 
being really a diminution, and the wasting 
increased by the pressure of the fat. The skin 
over the affected muscles retains its sensibility, 
there is unusual sensitiveness to cold, and the 
temperature of the affected parts is lowered. 
Occasionally there are neuralgic pains, most 
marked at the commencement of the disease. 
The general health seems moderately good, and 
the intellectual powers are unimpaired. Com- 
plete recovery is rare, but the progress of the 
disease is at times arrested. 

Treatment. — Carbonate of iron, three grains 
twice a day after food. Several spoonfuls of 
cream daily an hour after dinner. A weak cur- 
rent of electricity for five minutes at a time 
thrice a week. Frictions of the wasted limbs, 
and occasional warm baths. 



204 Dr. J. Kean's Lectures. 

INFANTILE PARALYSIS 
Is a form of palsy of obscure origin, which 
occurs among children during teething — that is, 
from the sixth month till the third year. It 
occurs suddenly, and never extends from the 
limb first attacked to others. There may be 
slight fever and convulsions; and when con- 
sciousness returns, a foot, a hand, a leg, or an 
arm, or both legs, may be paralyzed ; but never 
a leg and arm on the same side; the bladder and 
bowels also are never paralyzed. The disease 
frequently ends in a day or two in complete 
recovery, but in most cases it is stationary and 
permanent. After a time the affected limb 
becomes soft, relaxed, and flexible, and gradually 
withers. The skin becomes thin, the fat is 
absorbed, the muscles waste, and even the bone 
is diminished. In the course of a year the dis- 
eased limb is much smaller than its fellow, the 
skin is livid, chilblains and ulcerations are easily 
formed on it. The general health may remain 
unimpaired and the sufferers attain great age. 

Treatment. — Persistent use of electricity at 
short intervals (the induced current) ; while the 
affected muscles retain their contractility, a cure 
may be hoped for. Rubbing the paralyzed limb. 

Take 

Quinine % grain. 

Iodide of potassium 3^ grain. 

Mix. 

Make three powders. 

Dose — One three times daily. 



Facial Paralysis. 205 

LOCAL PARALYSIS 
Is paralysis limited to particular sets of muscles, 
of which there are many varieties. 

FACIAL PARALYSIS 

May be due to disease or injury of the facial 
nerve; but most frequently it occurs from ex- 
posure to cold or irritation from decayed teeth. 
The attack is usually sudden and unattended 
with pain, and is discovered by the patient when 
he begins to eat, or he is told that his mouth is 
awry by the first friend who might perchance 
meet him. When the face is at rest, the para- 
lyzed side looks slightly flatter and more flaccid, 
and hangs down, the palsied angle of the mouth 
is lower than the healthy one, the nostril is nar- 
rower, and the tip of the nose and mouth are 
drawn over to the unaffected side. When speak- 
ing, and still more when laughing, the angle of 
the mouth on the sound side is drawn upwards 
and outwards, but the paralyzed side remains 
perfectly motionless, blank and unmeaning, giv- 
ing a very peculiar appearance to the face. The 
cheek puffs out with each breath and food accu- 
mulates in it, having to be dislodged with the 
fingers. Whistling, blowing, and expectorating 
are impossible. There is a loss of taste in the 
front two-thirds of the tongue, and dryness of the 
mouth on the affected side. The palate and 
uvula are paralyzed, hang down, and are drawn 



206 Dr. J. Kean's Lectures. 

to the sound side. The forehead is smooth, and 
cannot be wrinkled as in frowning. The eyes 
remain permanently open from paralysis of the 
eyelids, but the eyeball retains its normal con- 
dition, the tears flow down over the cheek, and 
sensation of the cheek is not affected at first. The 
difficulty is purely local, and is usually curable 
with facility. Contraction of the diseased mus- 
cles is apt to follow the palsy. 

Treatment. — Leeches behind the ear of the 
affected side, followed by blisters also behind 
the ear, and strychnia one-thirtieth of a grain, 
daily. Friction over the paralyzed part and 
electricity thrice a week. If the muscles con- 
tract they must be stretched or pulled out. 

PARALYSIS AGITANS 

(Shaking Palsy) 
Is characterized by an involuntary trembling or 
jerking movement of the muscles, with diminished 
muscular power. It commences in the hands and 
arms or head, and gradually extends over the 
body. It may be caused by prolonged exposure 
to cold, or by violent emotions, and is most com- 
mon after forty years of age. The senses and in- 
tellect are unaffected. The trembling is worse 
when the person is watched or pays much atten- 
tion to it ; in some cases it is so severe that not one 
spoonful of food out of three lifted to the mouth 
is swallowed. The person stands stooping for- 



Scrivener'* Palsy. 207 

wards, and when he begins walking there is a 
strong tendency to pass into a slow running pace, 
the walk resembling a man on springs; each time 
he puts down his foot the jerking step seems as if 
it would upset him to the opposite side. 

It is a very intractable affection, and few reme- 
dies are of any use, attention to the general health, 
with occasional use of cream and iron, being all 
that can be done. I know a man in whom it has 
remained stationary, becoming neither better nor 
worse, for upwards of ten years. 

SCRIVENER'S PALSY 
(Writer's Cramp) 
Consists of morbid excitement of the motor 
nerves which supply the muscles of the thumb 
and fingers that hold the pen, resulting in a want 
of regulating power and cramp which renders 
writing impossible. It begins with a slight sense 
of fatigue of the hand, and a sense of insecurity, 
as if the writer must grasp the pen more firmly. 
Every attempt to write calls forth uncontrollable 
movements of the thumb and two first fingers, so 
that the pen starts up and down and forms gro- 
tesque interrupted scribbling. The more the 
patient tries to continue his writing, and the more 
attention he pays to it, or the more dread he has 
of the cramp, so much stronger is the spasm, and 
is apt to extend up the arm. The moment he 
ceases writing the palsy ceases, and he can exe- 



208 Dr. J. Kean's Lectures. 

cute all other combined movements undisturbed. 
Narrow coat-sleeves which compress the muscles, 
an inconvenient attitude, and, above all, a hard 
steel pen, favor the development of the affection. 
The disease is not entirely confined to the opera- 
tion of writing. Shoemakers, milkers, nail- 
makers, musicians, and men who handle small 
hard articles with considerable muscular grasp, 
are subject to similar cramps. 

Treatment. — Kest from writing, and the elec- 
tric current, with milk or cream. When the dis- 
ease is beginning, syrup of the phosphate of iron, 
quinine, and strychnia, a teaspoonful daily. 

GLOSSO-LARYNGEAL PARALYSIS. 

(Progressive Palsy of the Tongue, Lips and 
Palate.) 

Embarrassment of speech first attracts atten- 
tion, the tongue is less supple and the speech be- 
comes thick, the patient cannot blow, whistle or 
expectorate, and the saliva runs from the corners 
of the mouth. Food lodges between the teeth and 
cheeks, because the tongue is unable to displace 
it ; at last the tongue lies motionless in the mouth, 
hollow in the middle, and with the edges raised. 
Palsy of the palate shows itself by the nasal voice, 
the palate hangs down and the tip of the uvula 
rests on the tongue ; when food or drink is taken, 
it regurgitates through the nose and mouth, and 
part may get into the windpipe, causing choking. 



Tetanus. 209 

The appetite remains good, but swallowing being 
impossible, constant hunger aggravates the dis- 
tress. Great weakness of breathing is soon added 
to the other symptoms, so much so that the 
patient cannot blow. The disease is generally 
fatal, and death may ensue by stoppage of the 
heart's action, unaccompanied by pain or noise. 
Treatment. — Electricity to the paralyzed parts. 

FUNCTIONAL DISEASES. 
TETANUS 

(Lock-Jaw) 
Is a disease which consists of long-continued, in- 
tense, painful contraction of some of the volun- 
tary muscles. At the first appearance this effect 
is produced by the action of comparatively trifl- 
ing irritants, which acting on the extremities of 
the nerves, throw the spinal cord into a state of 
excitement. As the disease progresses, the spinal 
cord remains permanently in a state of excite- 
ment independently of such irritants. The most 
common causes are injuries, especially punctured 
wounds, and sudden changes of temperature — 
hot days and cold nights. It may also arise in- 
dependently of injuries, from exposure to cold, 
damp and chills. Some poisons, especially 
poisonous doses of strychnine, produce exactly 
similar symptoms, the only difference being that 
the artificial tetanus is more rapidly fatal. 

14 



210 Dr. J. Kean's Lectures. 

The symptoms usually commence some time in 
the second week after the injury, often a wound 
from a rusty nail, and the quicker the disease 
appears the more likely is it to be fatal. The 
first thing noticed is a stiffness of the muscles 
of the neck, throat, and jaws, causing sore throat 
and stiff* neck and a difficulty in bending or turn- 
ing the head. There is a peculiar appearance of 
the face, by the contraction of the muscles above 
the eyebrows. The stiffness and uneasiness soon 
increase and extend to the root of the tongue, 
causing difficulty in swallowing; the mouth 
opens with difficulty, and at last the jaws close 
completely, sometimes gradually, but always 
with great firmness. At length there is acute 
piercing pain and a sense of traction at the lower 
end of the breast bone. When the disease pro- 
ceeds the remaining muscles of the face, trunk 
and extremities become involved, forming four 
different varieties, according as the muscles most 
affected bend the body backwards, forwards, side- 
ways, or all muscles affected equally. The spasms 
never entirely cease except in a few cases during 
sleep, and there are aggravations of the spasms 
about every quarter of an hour, the increase last- 
ing for two or three minutes. In the most 
common form, that in which the body is bent 
backwards, in addition to the symptoms already 
described, which are those of lock-jaw proper 
(trismus), the other muscles of the face are 



Tetanus. 211 

affected, the forehead is wrinkled, the brows knit, 
the nostrils dilated, the angles of the mouth are 
drawn outwards, and the lips apart, exposing 
the clenched teeth, and giving to the patient a 
wretched grin (risus sardonicus). The eyes are 
rigidly fixed and sunk in their sockets. The 
characteristic of this variety, however, is a pow- 
erful contraction of the muscles of the back. 
When the paroxysms occur the middle of the 
body is jerked up, so that no part of it touches 
the bed except the back of the head and the heels. 
The muscles are as hard as stone, and are the seat 
of excruciating pain, comparable to severe cramp 
of the nether limb. At the commencement of 
the disease the paroxysms do not occur sponta- 
neously, but are produced by the most trifling 
cause, such as a touch on the skin, a draught of 
cold air, shaking of the bed, slamming of a door, 
movements of the patient, and even mental emo- 
tions. He suffers from hunger and thirst, which 
cannot be relieved ; the skin is covered with per- 
spiration, pulse is small and quick, the bowels 
constipated, temperature is very high, breathing 
is very difficult, the chest being compressed as in 
a vise from the contracted muscles ; sleep, though 
ardently longed for, is impossible, or only in 
broken slumbers; notwithstanding all this suf- 
fering, the intellect is clear and unaffected. As 
the disease progresses the paroxysms become 
longer and more frequent, and the short interval 



212 Dr. J. Kearts Lectures. 

is less perfect. The patient lies with, his arms 
close to his sides and inferior extremities ex- 
tended, fearing lest the slightest movement should 
produce a renewal of the paroxysm. Death gen- 
erally occurs the third to the fifth day, from 
breathlessness or exhaustion. 

Treatment. — A uniform temperature, without 
draughts in a darkened room. Moderate action 
of the bowels by an injection of a tablespoonful 
each of castor-oil and turpentine; ice applied 
along the spine. When the patient cannot swal- 
low fluids, injection of milk and beef tea, a small 
teacupful at a time. To soothe the pain, tincture 
of Indian hemp, 30 drops every hour, till its effect 
is seen ; cautious inhalation of chloroform to re- 
lieve the paroxysm and subcutaneous injection 
of curare, half a grain every six hours, are val- 
uable but dangerous remedies, and should only 
be given by a medical attendant of undisputed 
skill, already proven by his past success. I have 
had one case of recovery which I attribute to 
their use. In the event of recovery the muscles 
remain more or less contracted for five or six 
weeks. 

INFANTILE CONVULSIONS 
Consist of a gradual but rapid contraction of some 
or all the muscles, making them hard and stiff, 
so that the joints cannot be bent, and soon fol- 
lowed by alternate contraction and relaxation. 



Infantile Convulsions. 213 

They may occur from time of birth till the eighth 
year, and are most common in infants a few 
months old. 

The cause may be teething, worms in the bow- 
els, or irritation of the skin ; terror and other 
emotions; disease of the brain or spinal cord; 
as a premonitory symptom of the various fevers 
and inflammations; improper feeding, persistent 
diarrhoea and other causes of weakness ; but the 
most common of all causes is indigestion or 
teething. There is often a marked hereditary 
predisposition to convulsions. 

When the attack occurs suddenly without warn- 
ing, it is almost always a premonitory symptom 
of one of the acute fevers or inflammations, and 
seems to take the place of the chill of older per- 
sons. For a day or two before the fit the child 
is restless during sleep, and sleeps with its eyes 
half open, twisting its face and grating its teeth 
from time to time, and it starts when touched. 
When awake it is peevish and irritable, cries a 
good deal, and often changes color. When first 
affected, " the child may utter a cry, lose con- 
sciousness, become rigid as a board, and ulti- 
mately commence to struggle with a fixed chest 
and suspended breathing ;" then alternate con- 
traction and relaxation begin over the muscles 
of the whole body, rarely on one side only; the 
limbs, fingers and toes are alternately bent and 
extended. The face at first pale becomes reddened 



214 Dr. J. Kean's Lectures. 

and slightly bluish, the veins Of the neck are 
swollen and project like cords, the eyes fill with 
tears, frothy saliva appears on the lips, the skin 
is bathed in perspiration, and the abdomen is 
inflated with air which has been swallowed, 
the head is thrown back, the eyes are turned up 
or roll in their sockets, the face is distorted, and 
breathing embarrassed. The spasms are at first 
rapid and limited, but gradually become slower 
and more extensive till a long-drawn, deep breath, 
followed by complete relaxation, terminates the fit. 
The duration of the paroxysm is usually from a min- 
ute or two to half an hour, and there may be a suc- 
cession of fits over a few hours to a day or several 
days. There are also local convulsions of one-half 
or a part of the body. Children a few days old are 
apt to suffer from convulsions of the muscles of 
the throat and breathing (inward fits) shown by 
rolling of the eyeballs during sleep, the eyes 
turned up, gentle moaning, difficult breathing, 
twitches of the muscles, and flushing of the face. 
Treatment. — Loosen the clothing and admit 
fresh air ; see if the dress has been too tight or a 
pin run into the skin. If teething, lance the 
gums where they are hot, swollen and tender over 
a tooth ; endeavor to remove the cause ; if it can- 
not be ascertained, a warm bath and a dose of 
tincture of aconite and gelsemium proportionate 
to age will do good. If there is continued stu- 
por, cold lotions to the head. If prolonged and 



Epilepsy. 215 

the child cannot swallow, injections of beef tea 
and milk, a few tablespoonfuls at a time, one to 
six, according to age. 

EPILEPSY 

(Falling Fits) 
Is a complex condition in which there is sudden 
loss of consciousness, accompanied as a rule by 
convulsions, and followed by exhaustion and 



The fit lasts from two to twenty minutes or more, 
and returns at variable intervals. Epilepsy occurs 
at all ages, but generally begins between ten and 
thirty years of age, and in many cases there is an 
hereditary tendency to it. 

Epilepsy may be conveniently divided into two 
forms: 1. Where there are no convulsions or 
only a few twitchings; 2. With convulsions. 
In the first form there may be only loss of con- 
sciousness for a few seconds, the eyes are fixed and 
the face pale ; there are no twitches, but he lets 
fall anything he may have in his hand. In a few 
seconds the attack passes off, and he recom- 
mences his business as if nothing had happened, 
and those around him may not have noticed what 
has occurred. If slightly more severe, he sudden- 
ly becomes giddy and seats himself [See Fig. 26] ; 
or staggers and sinks to the ground without outcry ; 
the face is pale, the eyes fixed, and a few convulsive 
twitches play over the face and arras. In a few 




Fig. 26 — Epilepsy without Convulsion 



Epilepsy. 217 

minutes he recovers and looks wildly around, not 
knowing what has transpired ; but after a few 
minutes, during which he is confused, he is again 
in a condition to resume his occupation. 

In the second form, which is the most common, 
there are in some patients warning symptoms, 
such as headache, spectral illusions, confusion ol 
thought, a sense of fear, a peculiar sensation 
(aura epileptica), compared to a stream of cold 
water or cold air, tingling, warmth, numbness, or 
creeping of insects, which begins at the extremity 
of a limb and ascends to the head. As soon as 
this feeling ceases, the convulsion commences. 

Whether warning symptoms are present or not, 
the attack usually begins with a peculiar, loud and 
terrifying cry [See Fig. 27] , the patient falling to the 
ground backward or sideways, convulsed and in- 
sensible, and the mouth covered with foam. 

The face is deadly pale at the moment of the 
fall, but immediately becomes flushed and red. 
The convulsions vary from the most trifling to the 
most frightful, terrific and long-continued strug- 
gles. In mild cases, only one limb or the face 
alone is convulsed, bat in the severer forms the 
convulsions are general and violent. The hair 
stands on end, the forehead is wrinkled, and the 
brows knit, the eyelids are quivering and half- 
open, showing the white of the eye, and the eyes 
are injected, convulsively rolling or squinting, the 
teeth are clenched, and the jaws are worked back- 



218 Dr. J. KearCs Lectures. 

wards and forwards so powerfully that the teeth 
are sometimes broken, the tongue and cheeks are 
often bitten, causing blood to mingle with the 
frothy saliva on the lips. Quick striking, twist- 
ing, and kicking of the limbs occur in turn, and 




Fig. 27— Aura Epileptica. 

with such violence as at times to cause disloca- 
tion. The fingers are generally bent, and the 
thumb pressed into the palm of the hand. The 
breathing is difficult and snoring, the skin is 
bathed in perspiration, rumblings occur in the 
stomach and bowels, and the stools and urine are 
passed unconsciously. During the entire fit, con- 
sciousness is so completely extinguished that the 



Epilepsy. 219 

patient is not aroused and does not betray signs ot 
pain even by falling into the lire and charring a 
limb. When the paroxysm has reached its height, 
the muscles relax and convulsions subside, 
breathing becomes free and the face natural, and 
the convulsion often terminates by a long sighing 
breath, and stretching of the limbs. After the 
attack is over, unless violently aroused, the 
patient generally falls into a deep sleep, with 
snoring breathing. If awakened from this, the 
patient looks blankly or anxiously around, does 
not know what has happened, and cannot account 
for being in bed or wounded ; the whole desire 
being to be allowed to sleep. When she awakes, 
she is sometimes in good health, but more often 
confused, low-spirited, exhausted and suffering 
from severe headache, all of which vanish in the 
course of the day. In some cases, every attack, or 
every severe attack, is succeeded by mental de- 
rangement, which may amount to complete mad- 
ness. The patient may have an irresistible inclina- 
tion to run, or may break into a violent rage on 
the slightest provocation. Memory and intelli- 
gence may be impaired or exalted for some days 
after the fit ; there may also be temporary paraly- 
sis, loss of voice, difficulty in swallowing, or 
asthmatic attacks. 

Weeks or months, and even years may pass 
before the next convulsion, but every successive 
attack strengthens the habit, and renders the in- 



220 Dr. J. Kearts Lectures, 

dividual more liable to future recurrences, and at 
length they become very frequent — several occur- 
ring in a single clay. Slight ones at night may 
occur for a time, and being preceded and fol- 
lowed by sleep, are not suspected by the patient 
nor his friends. 

A repetition of attacks in course of time nearly 
always changes the mental and physical habits 
of the patient. Acuteness of judgment is lost; 
memory and the power of imagination diminish ; 
the gentler and nobler impulses recede more 
and more ; while the excited and violent propen- 
sities often impel the patient to commit violent 
or criminal acts. The patient becomes odd, ca- 
pricious, troublesome, and apt to burst into vio- 
lent fits of anger. The personal appearance is 
also changed : the features become coarse, with 
swollen eyelids, thick lips, a faltering look and 
clumsy body. The most beautiful countenance 
becomes deformed. Inveterate epilepsy often 
ends in permanent and incurable idiocy or in- 
sanity. The more distinctly hereditary it is, the 
longer it has continued, the more frequent and 
violent the convulsions, and greater the effects 
they leave, the less chance is there of recovery. 

The causes are various, the most frequent 
being hereditary tendency, and from intemper- 
ance and mental disturbance in parents, or 
marriages of near relatives. In children the irri- 
tation of teething or worms is also a common 



Epilepsy. 221 

cause. Strong mental emotions, such as a vio- 
lent fright, injuries to the head, and pressure ot 
tumors on nerves, are also important sources. 

Where the epilepsy has been brought on by 
some temporaiy cause, there is often spontaneous 
cure at puberty and at majority. 

Treatment — 1. During the fit : The chief ob- 
ject is to prevent the patient hurting himself. 
He should be placed on a sofa or bed with the 
head raised and the dress immediately loosened ; 
fresh air should be freely admitted, and cold 
water applied to the head; a piece of soft wood 
the full width of the mouth should be placed be- 
tween the teeth to prevent injury to the tongue, 
and the result awaited. The patient should not 
be bound or held fast during the fit. After it is 
over those generally feel best who have been 
allowed to struggle through it unmolested. 
Whenever circumstances permit, an epileptic 
should not be allowed to go unwatched, so as to 
give assistance if needed ; for example, during a 
fit in bed he might turn on his face and be suffo- 
cated. 

2. During the interval : Diligently search for 
the probable cause, and, if possible, remove it. 
The patient's general health, diet, occupation, 
and habits, mental and otherwise, must all be in- 
quired into to endeavor to find the origin. 

When there is severe headache, a blister to the 
back of the neck and purging by a compound 



222 Dr. J. Keartis Lectures. 

colocynth pill are of use. If there are worms in 
the bowels, eight drops of turpentine, daily, for 
three days, should be given; turpentine seems 
to do good independently of its action on the 
worms. If a scar or tumor presses on a nerve, 
removal by operation may cure the epilepsy. 
Many remedies have been employed with more 
or less success in epilepsy, such as belladonna, 
quinine, iron, valerian, sulphur, camphor, rue, 
oil amber, etc. ; but the most successful hitherto 
has been bromide of potassium in considerable 
doses and long continued. For an adult 12 
grains, daily, increasing one grain every fifth 
day till eighteen are taken daily. The good 
effect is shown by the fits occurring at longer 
intervals, and especially by their growing feebler. 
When a warning symptom (aura epileptica) runs 
up a limb, a strap buckled tightly round the 
limb where it is felt at times prevents the fit, but 
the next one is said to be more severe in conse- 
quence. 

Epilepsy is nearly always suspended during the 
course of acute fevers, and is sometimes perma- 
nently cured in this way. When there is sleep- 
lessness in an epileptic, hyoscyamus is to be pre- 
ferred to opium. The sufferer must never be 
allowed to be where the occurrence of a fit might 
occasion an accident. The bed he sleeps in should 
be low, lest he be injured by a fall ; the fire in 
his room should be protected by a strong guard ; 



Spasms. 223 

riding on horseback, shooting, fishing, or other 
similar exertion should be forbidden ; but gentle 
exercise in the open air with company is to be 
encouraged. He should have nourishing diet, 
warm clothing, and moderate exercise of both 
mind and body. 

The impostor who feigns epilepsy does not fall 
violently, but throws himself down in such a way 
as to avoid injury; the pupils of his eyes contract 
with light instead of being insensible to it as in 
a true fit; his skin is hot instead of cold and 
clammy, the tongue is not bitten ; and powdered 
capsicum blown into the nostril changes the con- 
vulsion into one of sneezing. 

SPASMS. 

(Cramp.) 
Cramps are continued or interrupted contrac- 
tions of the muscles, not caused by disease of the 
brain or spinal cord. It is usually attended by 
rigidity, much pain, and continues for a short 
time. It may attack either voluntary or invol- 
untary muscles. Of the former, the calves, 
feet, neck and hands are most frequent ; of the 
latter, in the stomach, or cramp of the bowels 
(colic). 
The following are the chief varieties of cramp : 
1. Spasm of the Muscles of the face (Mimic Spasm 
of the Face). — Grimaces occur either intermittent 
or constant, involving one side of the face, rarely 



224 Dr. J. Kean's Lectures. 

both; the attacks set in suddenly, and as sud- 
denly subside. The muscles feel hard and tense 
and impede motion, so that the eye on the affected 
side cannot be completely closed. At first the 
affected side is painful, but soon abates. 

2. Of the Muscles of the Neck (Salaam Convul- 
sions). — There is rapid contraction of one or both 
the front muscles of the neck, causing incessant 
nodding of the head. 

3. Of the Limbs. — This is the most common 
seat of cramp, and is not unfrequently caused by 
rheumatism, cold, damp, or irritation of the 
bowels. It is sudden, and often occurs at night, 
the patient being awakened by it from sleep. 
During its continuance the muscles are gathered 
into a knot, which is always easily felt and may 
often be seen. The pains attending are very 
severe, at times so agonizing as to cause fainting. 

4. Spasm of the Bladder, which is generally 
reflex and causes great distress with sudden, vio- 
lent desire to pass urine. 

Cramp usually continues only a few moments, 
but it may last for hours, and leaves for a time a 
soreness to touch and inability to use the part. 
The attack may cease gradually or suddenly, and 
may be limited to one muscle or extend to several. 
Some people have a remarkable tendency to 
cramp; movement of certain muscles being 
almost certainly followed by it. 

Treatment. — During the attack, kick out the 



Laryngismus Stridulus. 225 

limbs and attempt to walk, or rub the muscles, if 
on the trunk, with a warm hand or dry flannel. 
Attend to the general health. Very commonly 
there is a disordered state of the stomach and 
bowels, which must be remedied. If gout or 
rheumatism exist, their appropriate treatment. 

LARYNGISMUS STRIDULUS 

(Child-Crowing) 
Is a spasmodic affection of the windpipe, of 
nervous origin, and occurs almost solely in 
infants and young children, most commonly 
between the fourth and tenth month. A consti- 
tutional predisposition to it often exists, as in 
some families almost all the children in succession 
are affected. The attack is sudden and without 
warning, except in a few cases where there is 
slight breathlessness. Like croup, for which it is 
at times mistaken, the seizure usually occurs at 
night ; the child suddenly awakes, or is attacked 
while awake with sudden difficulty of breathing, 
the breath is drawn in with a loud whistling 
noise, compared to the crowing of a young 
rooster, and which is produced by the contracted 
muscles narrowing the chink of the windpipe 
(glottis). 

The eyes are fixed and staring and the face 

shows great distress, the child sits up or bends 

forward to favor breathing, and not unfrequently 

there are steady contractions of the thumbs and 

' 15 



226 Dr. J. Keaii's Lectures. 

lingers which are bent towards the palms, and of 
the toes, which are flexed toward the soles of the 
feet; these contractions are attended with pain, 
and any attempt to straighten the fingers or toes 
causes increased pain. If the convulsion con- 
tinues for any length of time, the face and limbs 
become bluish or purple. At length the parox- 
ysm ends as suddenly as it came, by a forcible 
expiration generally followed by a fit of crying. 
After a few minutes, as soon as the child has for- 
gotten his fright, he is completely restored, or if 
the convulsion has lasted some time, he is com- 
pletely exhausted and falls asleep. The fit may 
return in a few hours or days ; when they follow 
each other rapidly they are apt to be accompanied 
hy general convulsions and may prove fatal. 
There is always a great tendency to relapse, 
which is to be feared for a considerable time, 
even for months afterwards. The disease is a 
reflex action from some irritation, the ordinary 
ones being : Irritation from teething ; irritation 
of the bowels from improper food or overfeeding, 
worms, constipation, or diarrhoea; irritation of 
the skin, usually from eruptions on the scalp; 
enlarged glands in the neck pressing on nerves. 
Treatment. — Place the child in a warm bath 
and dash a little cold water over the head and 
face ; hold a sponge filled with hot water to the 
throat, and when it cools dip it again into the hot 
water and reapply it. Slap the chest with a 



St Vitus'* Dance. 227 

towel saturated with hot water ; the vapor of am- 
monia to the nostrils; as a last resort, opening 
the windpipe : but this should not, as a rule, be 
attempted by any except a qualified medical 
attendant. During the interval between the con- 
vulsions, measures should be taken to prevent its 
recurring. Lance the gums if they are swollen, 
hot, and tender. Attend to the state of the bowels ; 
a purgative is usually required; take a teaspoon- 
ful of castor-oil. If there is a skin eruption, 
soothing applications as dilute solution of acetate 
of lead. If there are enlarged glands, three 
tablespoonfuls of cream followed in half ao hour 
with five drops of the iodide of iron twice daily. 

CHOREA 
(St. Vitus' s Dance) 
Is an irregular convulsive action of the voluntary 
muscles, especially of the face and limbs. It is 
rare before the sixth year and after the fifteenth, 
and is most common at the periods of second den- 
tition and approach of puberty. 

The affection is more common in girls than in 
boys, and as a rule commences very gradually. 
The child seems awkward and often drops things ; 
in eating, the fork misses the lips, and in drink- 
ing, the beverage is apt to be spilt; the child does 
not sit stili, and makes grimaces which may 
wrongly be attributed to mirth, for which it may 
be scolded or chastised, with the result of making 



228 Dr. J. Kean's Lectures. 

the affection worse. Pati ents suffering from chorea 
are unusually sensitive and very easily alarmed, 
in mind as in body, never constant but rapidly 
changing from one idea to another. As the dis- 
ease progresses by degrees almost all the volun- 
tary muscles are affected; in the face, the eye- 
brows are alternately contracted and relaxed, the 
forehead wrinkled and smoothed, the eyelids rap- 
idly winked and then fast closed for a moment, 
the eyes roll, the mouth successively pursed up, 
opened and closed, drawn into a smile, and then 
down as in weeping ; the tongue is often thrust 
forward, the arms are jerked about, and move- 
ments occur in the elbows, hands and fingers. 
The nether limbs are also affected, though to a 
less extent, giving a characteristic gait to the 
patient while walking. The voluntary move- 
ments are awkward and uncertain from being 
complicated with the involuntary. The face ap- 
pears vacant and foolish from the different move- . 
ments though the mind is quite sound. The 
movements become worse when the patient is 
watched, or when she pays much attention to 
them. One side is generally more affected than 
the other, or it may be confined to one side or to 
the muscles of the face. The speech becomes 
impeded, the temper irritable and the appetite 
irregular, but the general health is little ■affected. 
From the constant movements it is difficult for 
the patient to sleep, but when once asleep the 



Hysteria. 229 

movements cease. The duration of chorea varies 
from six weeks to four months, and is often pre- 
ceded, accompanied or followed by rheumatism 
or heart disease. The cause is often obscure, 
but seeing a person affected with it is apt to 
cause an attack in children predisposed to it, and 
from this cause it has at times been epidemic in 
boarding schools. A sudden fright is not an un- 
usual cause, as are also irritation from the teeth 
or worms in the bowels. 

Treatment. — Remove the cause if possible; 
have an irritating tooth extracted; if there are 
worms, a dose of santonin ; have the bowels moved 
by 2 grains of leptandnu at the beginning of the 
attack. A cold shower-bath daily, or for delicate 
children use tepid water for a time at least. Car- 
bonate of iron, 3 grains thrice a day after food. 
To procure sleep, if necessary, }£ grain of the ex- 
tract of Indian hemp. The food should be light 
and nourishing. 

HYSTERIA 

Is a disturbance of the nervous system character- 
ized by extreme exaggeration of the sensations. 
It is almost exclusively confined to females, aud 
usually occurs from the time of puberty to the 
change of life. 

There^re two mental conditions generally found 
in hysteria, although they are not peculiar to it, 
but belong rather to invalidism in general. One 



Hysteria. 231 

is a tendency to imitation, in which the patient 
believes she is afflicted with any disease which 
may strike her imagination or of which she 
chances to hear. The other is a diseased egotism 
which makes her delight in being ill, so that it 
secures the undivided attention and [see Fig. 28] 
sympathy of those about her. This is at the bot- 
tom of those marvellous and otherwise unaccount- 
able tricks to which hysteric patients resort in 
feigning disease. A tendency either from birth 
or acquired by injudicious training has an 
obvious influence on the production of hys- 
teria, the forms and degrees of which are so 
numerous as to make it very difficult to describe 
properly. 

It is usually divided into three forms: — 1. 
Where there is the sensation of a ball rising in 
the throat {globus hystericus), or a feeling of suffo- 
cation without convulsions. 

2. The hysterical fit, where the sensation of a 
ball rising in the throat is accompanied by con- 
vulsions. 

8. Irregular and anomalous forms which often 
occur in the intervals of the paroxysms. 

The milder forms, which terminate without a 
convulsion, begin with pains generally in the left 
side, or the patient is unusually nervous, excited 
or depressed ; after a time there is the sensation 
of a ball rising from the stomach to the throat, 
sometimes causing an intense feeling of suftbca- 



232 Dr. J. Kean's Lectures. 

tion. The attack then ceases and is followed by 
weariness, headache, a copious discharge of pale 
urine and great flatulence. 

The fit of hysterics may be preceded by pains 
and mental feelings, but often is quite sudden and 
is excited by some passing excitement. The 
patient bursts into a fit of convulsions, laughing 
or crying, the sensation of a ball commences, as 
soon as it reaches the throat she falls to the ground 
apparently unconscious and violently convulsed. 
During the fit she may beat her breast with her 
hand, knock her head against the bed or floor, 
tear her hair or clothes, laugh or cry, scream, 
shriek, or sob. The face is flushed, the head is 
generally thrown back so that the throat projects, 
the eyelids are closed but quivering, the nostrils 
distended. During her struggles she may bite 
herself or the bystanders, and breathing is ren- 
dered slow and difficult. 

The fit generally ends with a flood of tears or a 
fit of laughter, followed by a great flow of clear 
urine, when recovery is completed. In other 
cases, the patient lies exhausted and unwilling to 
be disturbed, and though more or less conscious 
of what has passed, she wishes to be thought 
ignorant of all that has taken place. Occasionally 
the action of the stomach becomes inverted and the 
fit ends with vomiting, and may be followed by 
quiet sleep. 

Irregular hysteria between the fits is still more 



Hysteria. 233 

various in its manifestations, and may simulate 
any disease. 

There is exalted sensibility or morbid irritabil- 
ity of one or more of the senses. In some the 
sense of touch is exalted so much that they can 
scarcely bear the weight of the bed-clothes ; they 
can perceive the most trifling differences in weight 
and temperature, and are thus able to distinguish 
objects with their eyes shut which people in health 
could not. The sense of smell may be exalted to 
a degree usually found only in brutes. In like 
manner sight, hearing, and the sense of taste may 
also be increased. They often cannot endure 
bright daylight, the odor of flowers, or spice in the 
food, and desire us to speak iD a whisper. Some 
hysterical patients who cannot endure the odor 
of flowers can tolerate or are even gratified by 
various disagreeable smells, such as the odor of 
asafoetida, etc. 

From the morbid increase of sensibility, many 
complain of pain in various parts of the body, 
the most common being headache fixed to one 
spot and feeling as if a nail had been driven in. 
Hysterical breast, in which the pain is severe 
and long continued, the patient being scarcely 
able to bear the rubbing of the dress. Pains in 
the joints, usually the knee and hip, and which 
are often of such severity and so long continued, 
as liable to be mistaken for grave inflammation. 
Hysterical imitations of hip-joint disease cause 



234 Dr. J. KearCs Lectures. 

no wasting of the muscles nor painful starting of 
the limb at night. A light touch on the skin is 
generally more painful than a heavy pressure; 
the reverse takes place in the true disease. 

Imitations of inflammations may be detected 
by the thermometer showing no increased 
temperature. 

According to authenticated statistics, among 
the upper classes, at least four-fifths of the female 
patients who are supposed to labor under diseases 
of the joints, labor under hysteria, and nothing- 
else. 

There is almost never-failing tenderness on 
pressure over the spine, which may be exquisitely 
severe, and has often been mistaken for disease 
of the spine. With respect to these supposed 
cases of disease of the spine, (I refer to the spinal 
affection in young persons,) the real disease 
is not found in a greater proportion than one case 
in twenty. 

In some cases palsy either of a limb or one 
side of the body occurs from excessive incapacity 
of the patient to make up her mind to move the 
limb, and so long as she is firmly persuaded 
that she cannot move it, she is really incapable 
of moving ; but even after it has lasted for months 
it may be cured by a sudden strong emotion, such 
as the house in which she is getting on fire. 

If any serious disease is simulated in hysteria, 
its symptoms should be carefully examined, as 



Hysteria. 235 

the patient's exalted sensibility may detect pre- 
monitory symptoms of the disease which are as 
yet unrecognizable, and so cause the patient to 
elect that disease for simulation. I have seen a hys- 
terical imitation of apoplexy and general paralysis 
when all the indications were against such a dis- 
ease, the patient making a perfect recovery in a 
few days, and yet where a subsequent death by 
apoplexy occurred about a month afterwards. 

From the increased sensibility many things are 
complained of as causing pain and uneasiness, 
of whose action we are unconscious during 
health. Thus the movements of the bowels, 
stomach, and heart are described as giving rise 
to peculiar sensations. 

Among the mental symptoms the most prom- 
inent is the rapid alternation in the spirits of the 
patient, passing suddenly from gaiety to gloom. 
As the real and imaginary impressions generally 
fill the patient with disgust or displeasure, she 
gradually becomes more and more depressed, 
sad and unhappy, till at length the constant and 
apparently unreasonable lamentations and weep- 
ing lire out the sympathy and attention of her 
friends and relatives, to regain which patients 
have undergone the most painful operations. 
The capacity of such a patient for inventing con- 
ditions calculated to excite notice or sympathy 
is something incredible ; hence we should accept 
all unusual reports with the utmost distrust. 




Fig. 29. — Hysteria Prostrate. 



Hysteria. 237 

Another form of hysteria is where the patients 
live in bed [see Fig. 29] ; they are tranquil, cheer- 
ful, have good digestion, and like the sympathiz- 
ing attention of their friends. They often believe 
there is a serious disease of the spine or womb, 
and that certain movements cause great pain. 
Much tact is required to persuade the patient to 
get well. 

Sickness, belching of odorless air, rumbling in 
the bowels, flatulence, feeling of fainting, palpi- 
tation, and frequent passage of an abundance of 
pale clear urine are characteristics of hysteria ; a 
certain constitution is also characteristic. The 
hysterical face may be recognized by the remark- 
able depth and prominent fullness of the upper 
lip, which is more or less thick ; there is also a 
fullness of the eye with a tendency to drooping 
of the upper lid. 

Causes. — Feebleness and bloodlessness, some 
derangement of the sexual functions (see G. B. 
published separately), depressing emotions, such 
as the loss of a husband or child, or disappointed 
love, sudden fright, etc. Hysteria is much more 
common among the middle and upper classes 
than among the poor. Patients who can com- 
mand the sympathy of friends and the attendance 
of a physician often fail in the mental resolution 
necessary to resist the attack and throw off the 
sensations of fictitious fatigue, while poor people 
cannot afford the luxury of indulging in hysteria, 



238 Dr. J. Kean's Lectures. 

and must exert themselves to resist the sensations. 

Treatment. — During a fit let the patient be 
laid down, the dress loosened, and fresh, cool air 
freely admitted, ammonia applied to the nostrils, 
and if the attack is at all severe, there is more 
virtue in cold water than any other remedy. A 
few quarts of cold water thrown over the patient 
will often instantly bring the worst case into a 
state of tranquillity. 

Sympathy and kindness aggravate the fit, while 
severity and cold water dashed in the face pre- 
vent it. 

During the intervals, attend to the general 
health, moderate exercise in the open air, a 
shower-bath daily, and tincture of gelsemium, 
1 drop in water thrice daily. 

NEURALGIA. 

Violent pain which returns in the part with 
renewed violence after periods of temporary, re- 
mission. In some cases neuralgia is a symptom 
of various cachexias, i. e., morbid state of the 
system, such as rheumatism, chlorosis, anaemia, 
malaria, and lead-poisoning. In other cases it is 
reflex (reflected) from various inflammations, as 
a decayed tooth or piece of bone ; from wounds 
of nerves by sharp instruments, or from pressure 
on nerves, as by a scar or growth of a tumor. 

There are two forms of pain to be distinguished ; 
one is a dull, continuous pain confined to certain 



Hysteria. 239 

points and increased by pressure ; not very severe, 
but annoying and persistent. After this has 
lasted some time, the second form occurs in par- 
oxysms, spreading from a point, the pain is deep- 
seated and agonizing, generally continuing for a 
few seconds only, but causing exquisite torture. 

The principal varieties of neuralgia are 

Tic Douloureux — (Facial Neuralgia). — Usually 
one, at times two, and seldom all three branches 
of the fifth nerve, which supplies sensation to the 
face, are attacked. 

The pain is in the forehead, eyebrow and upper 
eyelid, sometimes also in the eye when the first 
branch is attacked ; after a time violent twinges 
of pain occur which last for a few seconds to 
minutes and return at irregular intervals. 

When the second branch is affected the pain is 
felt in the lower eyelid, the side of the nose, the 
upper lip, and teeth of the upper jaw. If the 
third branch be involved there is pain in the 
teeth of the lower jaw, the chin, and lower lip. 

The attacks may occur spontaneously or be 
excited by speaking, sneezing, blowing the nose, 
chewing, hot or cold food, or even mental excite- 
ment. 

Megrims — (Sun Pain) — Is a combination of 
headache and neuralgia occurring in paroxysms 
and confined to one side of the head. It often 
commences in childhood and continues until 
advanced age, occurring a few times every year. 



240 Dr. J. Kean's Lectures. 

It occurs in both sexes, but much more fre- 
quently in women, usually during the monthly" 
periods, and tends to diminish after middle age. 
The spell begins gradually after waking in the 
morning with slight chill, loss of appetite, slimy 
taste in the mouth, sickness, and intense head- 
ache ; the eyes are very sensitive to light and the 
ears to sound, so that the darkest and most retired 
rooms are sought for and absolute seclusion 
desired. At the height of the attack there is often 
vomiting of a bitter, greenish fluid. Generally 
towards evening the patient falls asleep and 
awakes next morning free from pain, but much 
depressed and exhausted. 

It is best not to try to defy it, but go to bed 
early and abstain from food and medicine till 
the paroxysm of pain is over. 

Sciatica. — Acute pain down the back of the 
thigh and limb. It is one of the most frequent 
forms of neuralgia, occurring most commonly in 
men over twenty years of age. Rheumatism, 
gout, and taking cold are the usual causes. The 
suffering as a rule commences gradually and 
slowly becomes severe. Tension of the facia (an 
inner sheathing under the skin) usually makes 
the pain worse, to avoid which the patient gener- 
ally keeps the limb bent and places the foot veiy 
carefully in walking, any quick motion or mis- 
step causing severe pain. If effusion takes place 
within the sheath of the nerve, there is intense 



Intercostal Neuralgia. 241 

agony, cramps, and starting of the inferior ex- 
tremity, succeeded by a dull aching, benumbing 
pain, and a feeling as if the limb were swollen. 

Sciatica is usually a very obstinate disease, 
continuing for months or even years, and liable 
to relapse. Even in favorable cases it lasts for 
several weeks and subsides gradually as it began. 
In chronic cases the affected limb is often sensi- 
bly wasted from want of use. 

Pleurodynia — {Intercostal Neuralgia) — Usu ally 
attacks the spaces between the ribs. It is more 
frequent in women than in men, and more com- 
mon on the left side than the right. There are 
often three spots very sensitive to pressure so that 
the patient cries out if they are touched. One is 
near the spine where the nerve deflects from it, 
another is on the side where the nerve divides 
into two branches, and the third is near the breast- 
bone where the nerve ends. The darting pain 
generally starts from the spine and passes for- 
wards. The constant agony is increased by a 
deep breath, sneezing, coughing, touching the 
sensitive spots, and at times by moving the arms. 
Hard pressure not unfrequently relieves the 
pain. 

Mastodynia — (Irritable Breast) — Is neuralgia of 
the nerve of the breast, usually in women under 
thirty years of age. Without any perceptible 
cause and it becomes sensitive to the slightest 
touch at one or more points, intense pain occa- 

16 



242 Dr. J. Kean's Lectures. 

sionally shoots out towards the shoulders, arm- 
pits, or hips. The patients cannot lie on the af- 
fected side and are unable to bear the weight of 
the breast, which may be slightly swollen, and at 
the height of the attack vomiting may set in. 
Sometimes the pain is of a wearying, aching char- 
acter, and there may be small movable tumors of 
connective tissue, the size of a pea to a hazel 
•nut, from which the pain emanates. The disease 
often continues for months or years without any 
perceptible change in the breast, and causes 
great anxiety as well as pain, for the patients 
generally dread "a cancer in the breast," espe- 
cially when there are little painful tumors. The 
general health is seldom good and should be 
attended to. A belladonna plaster ought to be 
worn over the breast to relieve the pain and a fur 
to shield it from the cold. 

In all the varieties of neuralgia there is tender- 
ness of the skin where the affected nerve leaves 
the main trunk, rarely the reverse. The nerves 
which pass through narrow openings in the bones, 
and supply parts of the skin exposed to cold, are 
the most often affected, for example, tic and 
sciatica. 

Treatment. — Remove every known cause, such 
as constipation, by a compound podophyllin pill 
night and morning, or if dyspepsia, by regulating 
dietary, or taking pepsine 15 grains after each 
meal. 



Disorders of t?ie Intellect. 243 

DISORDERS OF THE INTELLECT. 

The premonitory symptoms of impending cer- 
ebral derangement can often be detected by the 
physician some time before they attract the atten- 
tion of the patient or his friends. The most 
usual are morbid alternations of temper, depres- 
sion of spirits, severe and frequent headache, gid- 
diness, loss of memory and confusion of mind, 
paroxysms of irritability and loss of temper 
without sufficient cause, inaptitude for business, 
weariness and fatigue of brain, a longing for 
death, a want of interest in former pursuits, rest- 
lessness by day and sleeplessness by night, defec- 
tive speech and flightiness of manner. The suf- 
ferer feels that he is not right, but does not like to 
consult a physician (see G. B. page 6, published 
separately), he shuns his old friends and may be 
tortured with blasphemous or obscene thoughts. 

It is, however, very common for patients out of 
health, especially from disorders of the digestive 
system, to suffer much needless anxiety, and to 
be harassed by unfounded fears of going mad; 
loss of memory, confusion, giddiness, restless- 
ness, etc., occur from fatigue and want of atten- 
tion, and the patient becomes frightened, broods 
over his condition till it becomes much worse, 
and presents a nervous imitation of commencing 
madness. These symptoms will disappear with 
the improvement of the general health, and 
should cause no anxiety. 



244 Dr. J. KearCs Lectures. 

To judge of his condition the individual must 
be compared with his former self, which is the 
only safe rule. 

Mental diseases are often accompanied by bod- 
ily disorders. 

Treatment. — Remove any and every apparent 
cause, among which may be a stoppage of any 
discharge, skin disease or any other affliction 
which may prey upon the mind of the patient. 
In the acute stage, prolonged hot baths with a 
cold cloth over the head, will often procure sleep 
more certainly than medicine. Sub-cutaneous 
injections of acetate of morphia one-sixth of a 
grain, are very reliable. Give gentle cathartic if 
the bowels are constipated ; take leptandrin pul- 
verized, 1 grain every two hours until the neces- 
sary effects are produced. 

Take 

Bromide of iron % drachm. 

Water 4 oz. 

Mix. 

Dose — One teaspoonful thrice daily. 

Generous diet and milk warm, if possible, from 
the cow. 

MANIA 

(Raving Madness) 

Is a disorder of the impulses with one or more 
of the passions almost always exalted. The reas- 
oning faculty, if not lost, is disturbed and con- 



Mania. 245 

fined. The ideas are abundant, erroneous, absurd 
and wandering; and the manner violent and 
excited. 

It may be acute or chronic, and rarely appears 
suddenly. At first there may be only trifling 
irregularities in the affections. The maniac may 
at first be either sad or gay, active, indolent or 
indifferent ; but he soon becomes impatient and 
irritable, neglects his business and family, and 
does the most strange and extravagant acts. De- 
lirium and reason alternate with each other, and 
so do causeless anger and despondency. The 
kindest domestic love merely irritates and pro- 
vokes him to the utmost fury ; he shows distrust 
of his relatives, sleeplessness sets in, and his 
mind becomes a perfect chaos; all is violence, 
effort, disturbance and disorder. Wild exclam- 
ations, laughing, etc., for hours together, with 
ceaseless angry, furious or destructive movements. 
He shows aversion to food, and gradually be- 
comes weak and exhausted. It is seldom that 
he is insane on one point only, as in monomania. 
Recovery is preceded by sleep, a desire for food, 
and a gradual cessation of agitation and de- 
lirium. Different varieties of mania are : Homi- 
cidal, the result of delusions, suspicions or enmity. 
A plausible reason is usually given for the at- 
tempt to kill — such as that the victim had persist- 
ently annoyed or conspired against the lunatic. 
Such homicidal impulses may exist with perfect 




Ptg. 30.— Melancholia. 



Melancholia. 247 

ability to manage all his business, and his be- 
havior otherwise may be quite correct and even 
considerate. 

In monomania there is usually one particular 
delusion. He may act quite rationally in other 
things, and even in his delusion there is often 
method in his madness. Thus a lunatic who fan- 
cies himself very large will carefully avoid all 
movements towards the door lest he should be 
crushed to death in his passage through it. 

Treatment. — See paralysis of the insane and 
kindred diseases. 

MELANCHOLIA 

Usually appears gradually. The patient becomes 
silent [see Fig. 30] and seeks entire solitude, for- 
getful, abstracted, in low spirits, indifferent, and 
shuns all exertion. There is loss of sleep, dis- 
turbed dreams, and disordered digestion. He is 
easily moved to tears, disregarding all coasolation, 
and is unwilling to move, talk, or take food ; while 
there is a great tendency to commit suicide. (See 
G. B. published separately.) There is often a 
fixed dull pain or sense of oppression in the head, 
which is bowed on the chest. Answers to ques- 
tions are given in monosyllables, or after a con- 
siderable pause. It occurs in three forms — as 
religious, hypochondriacal, which is usually 
associated with indigestion, and homesickness, 
where death results from general exhaustion. 



248 Dr. J. KearVs Lectures. 

rp . TREATMENT. 

Dilute nitric acid K oz - 

Infusion of calumba 1 pint. 

Mix. 

Dose — Two tablespoonfuls twice daily, after 
breakfast and dinner. A shower bath daily and 
open-air exercise. 

DEMENTIA. 

The condition of intellect in which weakness 
is the prominent feature. It may follow mania, 
melancholia, or sunstroke, or coma in extreme 
old age. The mental faculties become dulled, 
confused, and finally altogether obliterated. If 
long continued there is a vacant and puzzled look, 
a weak smile and a meaningless laugh. The 
ideas are confused, vague, and wandering; the 
memory is much impaired — forget what they have 
just seen or heard, and are ignorant of the most 
common properties of time, place and quantity. 
The manners are hesitating, silly, and childish. 
They have neither affections nor aversions, but 
have paroxysms of excitement and restlessness. 
There is little control over the bladder and bowels, 
and in the last stage may pass into complete 
paralysis. 
GENERAL PARALYSIS OF THE INSANE. 

There is failure of nerve power, muscular weak- 
ness, and convulsions of the nature of epilepsy 
and apoplexy combined, with degeneration and 
wasting of the brain, leading to complete paraly- 
sis of body and mind. 



General Paralysis of the Insane. 249 

The disease begins with a sense of weariness 
and fatigue after little exertion in the lower 
limbs. The patient is restless and walks to and 
fro without any definite object. As the disease 
advances more attention is given to the walk ; the 
steps are short and shuffling, the foot comes down 
flat on the ground, while the legs are thrown out- 
wards, straddling rather than walking. The first 
symptom is often an impediment to the move- 
ments of the tongue, causing hesitation and defect- 
ive speech, accompanied by convulsive tremblings 
of the lips. The speech becomes thick, and the 
face a mask devoid of intelligence. When the 
patient is made to stand he balances on both 
limbs as equally as possible, and the position of 
the hands and arms is constrained. Muscular 
weakness may exist for some time before the 
mental disorder shows itself. When it appears it 
is characterized by delusions of grandeur, such 
as possession of great wealth or power. The 
patient is generally in high spirits and good 
humor, except when thwarted or contradicted, 
when he bursts into a violent rage and may be 
dangerous. The temper is irritable and suspi- 
cious, and his ideas vary from day to day. The 
intellect gets slowly weaker, the memory fails, 
handwriting is changed, moral character becomes 
debased, the patient is insensible to pain ; on pro- 
truding the tongue it curves tremblingly from 
side to side ; the pupils, which are contracted at 



250 Dr. J. Keari's Lectures. 

first, become subsequently dilated and slower in 
responding to light. 

The stools and urine pass involuntarily, either 
from paralysis or want of attention, and convul- 
sive seizures are not uncommon. As the disease 
progresses swallowing becomes impaired, the 
mouth is filled and the food rolled from side to 
side. There is also danger of its getting stuck in 
the throat and choking the patient. Reflex action 
weakens and also the irritability of the muscles 
to electricity. All instinct of decency is lost. 
The patient is gradually rendered unable to speak 
a single word, and cannot walk or stand from 
weakness, but continually grinds his teeth. 
Finally, all traces of intelligence are lost; he 
remains motionless, insensible, in a state of living 
death. Death generally takes place suddenly dur- 
ing or after one of the convulsive attacks, which 
if he survives leaves congestion of the brain. 

The symptoms steadily advance from bad to 
worse, with occasional remissions. Few survive 
for three years, the average duration being about 
thirteen months. 

mi TREATMENT. 

Bromide of iron % drachm. 

Water 4 oz. 

— — Mix. 

Dose — Teaspoonful three times a day. 

When food is refused any derangement of the 
stomach or bowels should be removed, and if the 
patient still refuses food he should be fed with 



General Paralysis of the Insane. 251 

stomach pump, or by injections of milk, beef-tea, 
and beaten-up eggs, a small teacupful at a time. 

For moral treatment the patient should be re- 
moved from his family at once in slight cases, 
that he may be induced to exercise such com- 
mand over himself as he possesses, and to remove 
him from influences which may have aggravated 
the difficulty; iD severe cases, to prevent him 
doing mischief to himself or others. 

All harshness and mechanical restraint must 
be avoided, and the patient's confidence obtained 
if possible. Every promise that is made must be 
kept, and as much indulgence as possible allowed. 
In certain conditions of excitement, however, it 
is proper to place the patient at once in a dark- 
ened room, remote from noise and from the means 
of injury to himself or others, so that as few 
objects as possible may irritate him. The effect 
is generally soothing. There are no more power- 
ful medicines than occupation, recreation and 
education. Occupation should be such that 
there is no time for idleness or brooding over 
morbid fancies. 

When reason is restored and the emotions are 
under control, the patient may be allowed to see 
his friends and attend to the affairs of his family. 
It should, however, be remembered that the mind 
remains weak and enfeebled for some time after 
the apparent recovery, and hence the patient's 
restoration to society should be gradual. 



LECTURE VI. 



Affections of the Eye — Catarrhal Ophthalmia. — Pustu- 
lar or Strumous Ophthalmia.— Purulent Ophthalmia.— 
Inflammation of the Cornea. — Ulcers of the Cornea.— 
Foreign Bodies in the Eye. — Iritis. — Cataract. — Short 
Sight. — Long Sight. — Weak Sight. — Astigmatism.— 
Strabismus. — Squinting. — Night Blindness. — Color 
Blindness. Affections of the Eyelids — Inflamma- 
tion of Edge of Lids. — Stye. — Inverted Eyelashes.— 
Bruises. 



AFFECTIONS OF THE EYE. 




Fig. 31.— The Eye. 

YTFHE eye, considered merely as an optical in- 
•Jl strument, is a wonderfully beautiful and 
complicated structure, resembling in many 
respects a good telescope. Diseases of the in- 
terior of the eye, and most of those affecting 



Affections of the Eye. 253 

vision, require to be treated by a skilled special- 
ist, who is a graduate from a standard college of 
ophthalmology, and the eye to be examined by an 
ophthalmoscope. The following short account 
of the structure and use of the parts of the eye 
may be of interest. 

The eyelids consist outside of thin skin, and on 
the inside of a smooth membrane, the conjunctiva ; 
between them lies a small circular muscle (orbic- 
ularis) going round both eyelids, the cod traction 
of which shuts the eye. Next there is a small 
half-oval cartilage or gristle (tarsal) with straight 
edge along the edge of the lid, and the round 
edge joined to a still thinner ligament (palpebral) 
or membrane which is joined to the bone round 
the eye. Next there is a row of fine straight tubes 
(Meibomian glands) like a hair, lying on the in- 
side of the lining membrane (conjunctiva), and 
the mouths of which open on the free edges of 
the eyelids. Finally the eyelashes are set in two 
or more rows at the junction of the skin and lin- 
ing membrane, the upper lashes being longer and 
more curved, which prevents their tangling. 

The conjunctiva or liniDg membrane, after lin- 
ing the eyelids, turns forward on the eyeball, 
a few glands opening into the fold. On the ball it 
becomes thinner, transparent, containing a few 
tortuous blood-vessels, and is loosely connected to 
the ball by a little tissue, so that it can be moved 
on pressing the ball with the finger; over the 



254 Dr. J. Keari's Lectures. 

clear part of the eye it is reduced almost to noth- 
ing. Through the ducts it is continued into the 
nose and lachrymal gland. 

The lachrymal gland, which secretes the tears, 
is about the size of a small almond, and lies at 
the upper and outer side of the eye, one part 
being attached to the back of the upper eyelid, 
the other part to the bone. The ducts of the 
gland, about a dozen in number, open into the 
fold where the conjunctiva turns forward. At 
the inner edge of the eyelids are two small pro- 
jections, each with a minute opening (puncta) at 
the top, which conveys the tears by two small 
ducts into the lachrymal sac, a small sac at the 
top of the nasal duct leading into the nose. The 
nasal duct is about half an inch long, and as 
thick as a small crow-quill. 

The eyeball is a slightly flattened globe with 
the broad side looking forwards. The clear part 
or cornea is a section of a lesser globe. The ball 
consists of three coats, and encloses three trans- 
parent optical materials, and is moved by six 
muscles, four straight and two oblique. The first 
coat, which is under the conjunctiva (the conjunc- 
tiva covers only a part of the globe), is called 
the sclerotic and forms the white of the eye, 
changing in front into a clear transparent mate- 
rial, the cornea, which forms the clear front of the 
eye. Inside the sclerotic is a dark brown coat, 
the choroid, mainly composed of blood-vessels 



Affections of the Eye. 255 

and color-cells, and which ends near the cornea 
in a series of plaits or folds, the ciliary pro- 
cesses. The dark choroid absorbs the light 
which has passed through the retina, and prevents 
reflection which would cause dazzling and con- 
fused sight. 

Animals which have no color in this coat are 
dazzled by strong daylight. In some animals 
there is a fine fibrous structure (tapetum chor- 
oideae), which refracts light, and makes them see 
better in twilight; this gives the green glow in the 
eyes of cats. Inside the choroid is the retina or 
membrane of vision, which is an expansion of 
the fibres of the optic nerve, and extends forward 
to the cornea. Exactly in the centre, and in the 
axis of vision, is a small yellow spot, which is 
the most sensitive part of the eye, about a tenth 
of an inch, to the inside of which is a round 
white spot, the entrance of the optic nerve, and 
the only blind spot in the eye. The optical ap- 
paratus consists of four different lenses, filling up 
the interior of the eye, and all of them under 
ordinary circumstances perfectly transparent. 
1. The cornea, which is nearly circular, and 
forms about one-sixth part of the whole globe; 
it is composed of about sixty different layers, and 
is overlapped at the edge by the sclerotic. It is 
so clear that one must look sideways through the 
eye of another person to see it properly. 2. The 
aqueous humor which is a watery fluid filling the 



256 Dr. J. Kearts Lectures. 

space between the cornea and the crystalline 
lens, and having the iris hanging in it. 3. The 
crystalline lens, one of the most remarkable 
bodies in nature. It is a biconvex lens, more 
curved behind than in front, composed of con- 
centric layers like an onion, and enclosed in a 
delicate Capsule. When freshly taken from an 
animal, its clearness can be compared only to a 
large dew-drop. 4. The vitreous humor. It is a 
clear stiff jelly, enclosed in delicate transparent 
meshes, and fills up the great bulk of the eye. 

In front of the crystalline lens, and hanging 
freely in the aqueous humor, is a curtain called 
the iris, and perforated iu the centre by a hole, 
which is the pupil of the eye. The iris is about 
half an inch in diameter, and contains radiating 
muscular fibres in front, by the contraction of 
which the pupil is enlarged, while there is a band 
of circular muscular fibres behind, at the edge 
of the pupil, by contraction of which the pupil 
is diminished. The color of the eye depends on 
the color of this curtain, and its movements, vary- 
ing the size of the pupil, regulate the supply of 
light to the eye. At the outer margin of the 
sclerotic and choroid, a small circular muscle 
lies between them, the ciliary muscle, by the con- 
traction of which the shape of the crystalline 
lens is changed, and the eye accommodated for 
long or short sight. A full account of the action 
of the eye would far exceed the design of this 



Conjunctivitis. 257 

work, but may be had in the text-books of Physi- 
ology and Anatomy. 

AFFECTIONS OF THE CONJUNCTIVA. 
CONJUNCTIVITIS. 

(Ophthalmia.) 
The conjunctiva is the lining membrane of 
the eye and lids. Like all other mucous mem- 
branes, it is liable to become inflamed from 
various causes, constituting ophthalmia, which 
is named according to the cause or consequence. 
In all the varieties the most prominent symptom 
is redness of the membrane, generally of a bright 
scarlet color, diffused or in patches. When the 
inflammation is severe, all the eye except the 
clear part, (cornea) may be a bright red, contain- 
ing enlarged tortuous vessels; by dragging 
slightly with the finger the conjunctiva may be 
made to slide over the deeper sclerotic coat, 
cariying its enlarged red vessels with it. 

CATARRHAL OPHTHALMIA 
Is the most common of all eye diseases, and may 
be produced by exposure of the eye to cold, or 
without apparent cause. There is a feeling of 
grittiness, as if fiDe sand had got into the eye, 
with some stiffness of the lids, and after slight 
pain or a sense of scalding. The membrane (con- 
junctiva) becomes red, beginning at the outside of 
the ball and fading as it approaches the clear part 
(cornea). As the affection advances, the white of 

17 



258 Dr. J. Kean's Lectures. 

the eye becomes a uniform bright red color. 
There is [see Fig. 32] increased secretion from 
the surfaces of the eye and lids, at first clear and 
viscid, but becoming thick and yellow. During 




Fig. 32.— Catarrhal Ophthalmia. 
sleep there is little discharge, so that in the morn- 
ing there is dryness of the eye, and eyelids are 
sticky and gummed together by the dried secre- 
tion. There is often also swelling of the mem- 
brane on the eyeball, (chemosis), sometimes so 
much as to make the cornea look sunken, and 
swelling of the lids in the meantime. The cornea 
is clear, and the pupil active on exposure to light, 
showing that the deep structures are not involved. 
Vision is generally impaired by motes of dis- 
charge, floating in the tears, and moved over the 
eye by the lids. Catarrhal ophthalmia usually at- 
tacks both eyes at once, or one may be affected a 
little before the other; it is seldom limited to 
one eye. 



Strumous Ophthalmia. 259 

It yields readily to treatment, leaving no trace 
behind, but if no treatment or unsuitable rem- 
edies be used, the inflammation may extend to 
the cornea, and cause ulceration. 

Treatment. — The patient should remain in a 
room of uniform temperature at the commence- 
ment of the attack. The eye should be bathed 
every four hours in a lotion of the following : 

Take 

Permanganate of potash, % grain. 

Distilled or rain water 1 oz. 

Mix. 

And at each application a little should be allowed 
to run into the eye, by opening and shutting it 
several times. To prevent the eyelids sticking to- 
gether during sleep, a little ointment, such" as 
dilute zinc ointment. When there is considerable 
inflammation, 

Take 

Nitrate of silver 2 grains. 

Distilled water , . . . 1 oz. 

Mix. 

Which is a most useful lotion ; one drop to be 
let into the eye twice a day, and the potash lotion 
used in the intervals. 

The discharge may be frequently washed oft 
with tepid water, and any lint or cloths used to 
wipe it should not be used a second time. 

STRUMOUS OPHTHALMIA 
Is the most common affection of the eyes in 
children, between the time of weaning and ten 
years of age. It is usually associated with scrof- 
ula, and, if neglected or mistreated, may cause 



260 Dr. J. Kean's Lectures. 

permanently injured vision, or even loss of sight. 
One or both eyes maybe affected from the first, but 
if both, one is usually much worse than the other. 
There are one or more small grey pustules or pim- 
ples at the margin of the cornea or clear space of 
the eye, preceded and accompanied by a burning 
or stinging pain, watering of the eyes, and intense 
intolerance of light (photophobia), which is 
greater in this than in any other disease of the 
eye. The child, in severe cases, keeps its eyes 
fast closed, and its face buried in the nurse's 
dress. On attempting to look at the eye, there is 
violent spasmodic closure of the lids; and when, 
after severe struggles, they are separated, the eye- 
ball is turned up so as to hide the pupil. The 
severity of the symptoms is often quite dispro- 
portionate to the apparent disease, which may 
consist of merely one or two small pustules on the 
margin of the cornea. At first they appear as 
vesicles, the contents of which soon become tur- 
bid and burst, leaving small ulcers which heal, 
leaving no scar. In some cases the whole eye is 
congested (bloodshot), in others there is only a 
scarcely perceptible tinge of color when opened ; 
but it soon flushes on exposure to light. 

Scrofulous ophthalmia is tedious in its progress, 
and very apt to recur. It may be brought on by 
impure air, improper food, and insufficient sun- 
light, and is generally associated with other signs 
of scrofula. 



Strumous Ophthalmia. 261 

Treatment. — Is chiefly to improve the general 
health. 

The food should be digestible and nourishing, 
with a considerable proportion of milk. The 
child should wear a shade, and be as much in the 
open air as possible, while the treatment must be 
continued for three months after the affection is 
subdued. 

Take 

Iodide of potash % oz. 

Compound syrup of stiliingia 4 oz. 

Mix. 

Dose — Half teaspoonful thrice daily; followed 
by syrup of iodide of iron half teaspoonful thrice 
daily. These sized doses for children, to be taken 
on alternate weeks until complete cure is effected 
(see precautionary rules, Lecture XVII). 

Of local applications, sulphate of atropine lotion 
one grain to an ounce of water, should be dropped 
into the eyes four times daily. The margins of 
the eyelids should be washed night and morning 
if they are gummed, and a little dilute zinc oint- 
ment applied to them at bedtime. 

There is another form of pustular ophthalmia 
in which the symptoms are very mild : there are 
one to four pustules of a reddish color at the base, 
and yellowish white at the top near the margin of 
the cornea. They do not contain pus, but merely 
a little watery fluid, and the conjunctiva round 
them is more or less reddened. There is no in- 
tolerance of light and seldom more than a slight 



262 Dr. J. Kean's Lectures. 

feeling of grittiness as of sand in the eye. This 
form is very apt to recnr. 

Treatment. — Attend to the general health and 
apply a little zinc ointment on the pustules with 
a earners-hair brush every second day. 

PURULENT OPHTHALMIA 

(Contagious) 
Commences with a slight discharge from the eye 
and swelling of the lids, together with a sudden 
feeling of sand in the eye and sticking of the 
lids. The discharge rapidly increases in quantity 
and in six to twelve hours changes to pus, the 
conjunctiva on the eyeball becomes swollen and 
rises above the cornea in a red ring (chemosis). 

The lids become red, shining and enlarged 
with fluid. If the disease progresses unchecked, 
the cornea becomes cloudy and may be flesh-like 
in appearance and then ulcerates, or a part dies 
and the eye is destroyed by the perforation, which 
is shown by a copious discharge of hot fluid, 
giving temporary relief to the pain. Sometimes 
the deep structures of the eye are aftected, caus- 
ing severe pain in the eyeball, aggravated at 
night and declining towards morning. 

The disease usually begins in both eyes at once, 
and may result in destruction of the eye from 
ulceration or sloughing. The eye may recover 
with a white opaque spot on the cornea, to which 
the iris may adhere, causing a distorted pupil. 
It may leave granular lids. 



Purulent Ophthalmia. 263 

This form of ophthalmia is apt to be epidemic 
in schools, probably from contagion. The dis- 
charge may amount to several ounces in twenty- 




Fig. 33.— Purulent Ophthalmia. 
four hours, and is violently contagious, the small- 
est trace of it touching an unaffected eye setting 
up the same disease in it. 

Treatment. — Same as catarrhal ophthalmia. 
The food must be nourishing — animal food, milk, 
beef-tea and wine. Any thick discharge must be 
wiped off by a piece of lint or cloth, which should 
immediately be burnt. Two drops of a solution 
of nitrate of silver, three grains to an ounce of 
distilled water should be dropped into the eye 
twice a day. A fold of linen moistened in iced 
water and laid over the eye during the intervals 
between using the lotion is very soothing to the 
patient ; it should be changed as often as it be- 
comes hot or dry. 

GONORRHEAL OPHTHALMIA 
(See G. B. published separately) is a violent spe- 
cific form of purulent ophthalmia, which begins 



264 Dr. J. Kearts Lectures. 

in one eye from contact of infective matter, and 
usually soon affects the other. [See Fig. 33.] The 
eye may be destroyed in a few hours in the worst 
cases. Treatment the same as severe purulent 
ophthalmia. When one eye only is affected the 
other should be covered with a bandage to pre- 
vent its infection. 

PURULENT OPHTHALMIA OF INFANTS 
When neglected or improperly treated, is a most 
disastrous disease, often causing total blindness. 
It usually commences from the second to the 
seventh day after birth, most frequently on the 
third day, and may be caused by contact with 
discharges during parturition (birth) or milder 
forms from soap, etc., getting into the eyes. On 
the morning of the third day after birth the up- 
per eyelid is somewhat swollen, the edge red, and 
the eyelashes glued together with a slight dis- 
charge from the eye. In a few days, often in a 
few hours, the discharge becomes thick and pur- 
ulent — in slight cases, of a whitish color and not 
very abundant ; in severe cases, deep yellow, and 
very profuse. The child becomes feeble, restless 
and fretful, with its eyes constantly shut. In this 
state it may remain for eight or nine days, when, if 
not relieved, the cornea becomes cloudy and 
ulcerates, causing destruction of the eye. 

Treatment. — Alum lotion, six grains to an 
ounce of water to wash away the discharge every 



Trachoma. 265 

half-hour during the day, and every hour at night ; 
nitrate of silver solution, 3 grains to an ounce of 
water, 1 drop placed in the eye three times a day. 
The easiest way to apply the lotion is to place 
the child on the nurse's lap, turn its head on one 
side, separate the lids with the thumb and finger 
of the left hand — being careful, as in all diseases 
of the eye, to rest the hand and fingers on the 
surrounding bone, and not to press unnecessarily 
on the eyeball — and gently force a stream of lotion 
from the syringe into the eye on the side next the 
nose, allowing it to run away between the lids on 
to a soft napkin placed below the head. 

TRACHOMA 
(Granulation of the Lids) 
Is a frequent result of purulent ophthalmia. The 
outside of the eye may appear quite healthy, but 
the patient complains of impaired vision, the 
sight is misty, and rainbow colors often appear 
round the flame of a lamp or candle. On turn- 
ing out the eyelid the inner lining is seen to have 
lost its bright polish and smoothness, and has 
become rough from numerous small projections, 
which may be bright red, dull red, yellowish, 
pale grey or bleeding. The cornea in course ot 
time, from the friction of the roughened lids, 
becomes cloudy, uneven, and with red vessels 
running into it, so that for all useful purposes 
the eye is practically blind. 



266 Dr. J. Kean's Lectures. 

Treatment. — Relieve the inflammation in all 
cases by increasing a flow of tears with the 
following : 

Take 

Solution of atropia 1 grain. 

Distilled water 1 oz. 

Mix. 

Or Take 

Permanganate of potash 1 grain. 

Distilled water 1 oz. 

Mix. 

A few drops in the eyes, night and morning 
Either of the above prescriptions is adapted to 
the case. 
To remove granulation : 

Take 

Nitrate of silver % drachm. 

Distilled water j| drachm. 

Mix. 

Or Take 

Liquor plumbi subacetate. Take solution full 
strength. 

Apply either one of the above with a sharpened 
stick to the granulated surface. First wipe with 
cloth to prevent its touching the cornea. If there 
are any ulcers they should be attended to by a 
slight application of nitrate of silver. 

These remedies ought to be applied with great 
caution, or by a surgeon whose past success has 
proven his superior skill. 

The following constitutional treatment in these 
cases is of the greatest importance : 



Affections of t?ie Cornea. 267 



Take- 



Iodide of potash % oz. 

Compound syrup of stillingia 4 oz. 

Mix. 

Dose — Teaspoonful three times daily. And — 

Take 

Syrup of quinine and iron. 
Dose — Teaspoonful thrice daily, to be taken on 
alternate weeks. (See precautionary rules, Lec- 
ture XVII.) 

AFFECTIONS OF THE CORNEA. 
CORNEITIS KERATITIS 
(Inflammation op the Cornea) 
Usually appears with a slight pink ring round 
the cornea, or a few patches only ; the eye is irri- 
table, and shuns the light ; the cornea begins to 
look heavy, and the sight is dimmed. There is 
generally a flow of tears and pain in and around 
the eye. The morbid action may remain for 
months and leave the cornea permanently cloudy, 
or the disease may continue and develop ulcer- 
ation. When recovery commences, red vessels 
run into the cornea, till in some cases it looks 
like a piece of red velvet (p annus). Gradually 
this clears and transparency is restored. 

The causes are ill-health generally, scrofula, or 
syphilis. (See G. B. published separately.) 

The inflammation may cause pus in the lay- 
ers of the cornea, either spread all over or in a 
small abscess, and may open inwards into the 
eye, or outwards. 



268 Dr. J. OCean's Lectures. 

Treatment. — Attend to the health generally 
with the treatment of the cause. Protect the eye 
from the light by a double shade, etc. 

Take 

Nitrate of silver 100 grains. 

Distilled water .1 oz. 

Mix. 

Apply carefully to the ulcer, with the aid of a 
magnifying glass and a camel's-hair pencil. 

Give the constitutional remedies prescribed in 
cases of granulated lids. 

ULCERS OF THE COENEA 

May occur at all ages, in people weakened by 
illness, insufficient food, scrofula, or other dis- 
eases of the eye. They are always accompanied 
with pain and a feeling of sand in the eye, dread 
of light and flow of tears. When the ulcer is 
confined to the surface of the cornea (epithelium), 
after healing, the eye regains perfect transpar- 
ency, but if the deeper parts of the cornea are 
involved, it leaves a white scar which never dis- 
appears. Superficial ulcers appear like a very 
slight scratch, (opacity,) dimming the bright sur- 
face of the cornea. One form of deep ulcer some- 
times runs round the outside of the cornea. If an 
ulcer perforates the cornea, the sight is lost, the 
aqueous humor flowing out, and with it the free 
edge of the iris. 
Treatment — Is the same as inflammation. 



Foreign Bodies in the Eye. 269 

. FOREIGN BODIES IN THE EYE. 

Grains of sand or dust, or particles of metal, 
are sometimes blown or projected into the eye, 
causing a copious flow of tears, and inability to 
raise the upper eyelid or to face the light. 

Treatment. — The cornea should be well 
looked over with an ordinary lens or magnifying 
glass, a very small particle stuck in the cornea 
sometimes giving rise to severe irritation. A broad 
needle should be run beside the particle, but not 
through the cornea, and with another needle it 
may be removed. Failing to find a body on the 
cornea the eyelids should be examined, the lower 
one by drawing it down and the upper one by 
turning out the inner surface over a knitting- 
needle, crow-quill, or the like. Having removed 
the foreign body, two drops of olive oil should 
be dropped into the eye, which ought not be used 
for two or three days. If there is much pain, the 
eyes must be fomented with belladonna lotion, 
three grains to an ounce of water. 

When hot fluids, or strong acids, or, most 
destructive of all, unslacked lime, get into the 
eye, it should be at once bathed with cold water, 
and two drops of olive oil placed in the eye. 



270 Dr. J. Kearfs Lectures. 

DISEASES OF THE IRIS AND CRYSTAL- 
LINE LENS. 
IRITIS. 
(Inflammation of the Iris.) 

Inflammation of the iris may be a primary 
disease, or it may be due to inflammation of one 
of the coats of the eye. The inflammation gener- 
ally appears to begin at the free margin of the 
iris and from thence spreads till it may affect 
other structures. There is a strong tendency to 
recurrence of the attack ; an eye that has once 
suffered is always more liable in future, especially 
in the rheumatic form. The chief symptoms of 
iritis are: 1. A delicate pink ring round the 
cornea, the color of which is brightest at the 
edge and fades away towards the white of the 
eye ; this color is due to a number of fine straight 
hair-like vessels running in towards the edge of 
the cornea, and is constant while the inflammation 
of the iris remains, disappearing when it ceases. 
The transparent conjunctiva can be freely moved 
over it. If the conjunctiva is inflamed, its color 
is bright scarlet, containing large tortuous vessels. 

2. A peculiar discoloration of the iris, which 
has a dull and glistening appearance ; if naturally 
blue or grey, it becomes of a dirty greenish or 
slate color ; if naturally dark colored, it becomes 
of a brownish red. The inflamed eye should be 
compared with the unaffected one. 



Iritis. 271 

3. The pupil is contracted and irregular in 
shape, and is immovable, or moves very slug- 
gishly when exposed to light. 

4. The iris may adhere in one or more places 
to the lens or cornea. 

5. Dimness of sight varying from a slight mist 
to total blindness. 

6. Pain in the eye, which may be slight or 
begin early and gradually become very severe. 
Pain round the eye at night. 

7. Fever and headache, with white tongue and 
disturbed sleep. 

All the above symptoms are not always or 
even often present, especially pain and fever, 
which may never be present. The chief causes 
are exposure to cold and wet, rheumatism, syphilis 
(see G-. B., published separately), scrofula, gout, 
and injuries. 

Treatment. — Best in a darkened room. The 
pupil to be kept dilated by two drops of a solu- 
tion of atropine, two grains to the ounce of 
distilled water, dropped into the eye every hour. 
A fold of linen saturated with solution of extract of 
belladonna, 5 grains to an ounce of water. After 
the first two days the drops to be used four times 
a day for two or three weeks. The bowels to be 
kept regular. If the cause is rheumatism or scrof- 
ula, iodide of potassium four grains every day, 
together with quinine two grains. Opiate, twenty- 
five drops of laudanum, may be required at night 



272 Dr. J. Kearfs Lectures. 

if the pain is severe. The food must be plain, 
nourishing, and free from stimulants. 

CATARACT 

Is an opacity of the crystalline lens or its capsule, 
or of both. It may occur from old age, constitu- 
tional disease, disease of the deeper parts of the 
eye, or injuries. There are two kinds, forming 
several varieties. Soft cataract, in which the 
lens is soft and cloudy, which may come on at 
any time from infancy to thirty-five years of age, 
or may exist at birth ; and hard cataract, in which 
the lens becomes firm and dark-colored, usually 
beginning at the centre, and which may occur 
any time after thirty-five years of age. Either 
kind may begin at the edge of the lens or in 
the centre, and one eye is usually affected before 
the other. The sight becomes obscured by a 
thick cloud, and continues till vision is reduced 
to a mere perception of light from darkness. 
The time taken to arrive at this stage is very 
variable, often many years. If the inside of the 
eye be sound, vision may be restored by an opera- 
tion to remove the opaque lens, convex cataract 
glasses being used afterwards to perform its 
function. 



Changes in Shape and Power of the Eye. 273 

CHANGES IN THE SHAPE AND POWER 
OF THE EYE. 

The eye is naturally set to see things at a dis- 
tance. When we look at things close at hand we 
unconsciously focus the eye, but not in the same 
way that a telescope is focused. We focus the 
eye by contraction of the ciliary muscle round 
the edge of the lens, which compresses the lens 
and makes it more convex (curved) in front, thus 
shortening its focus. Short sight may be caused 
by a permanent state of contraction and increased 
curvature of the lens, but more commonly it is 
caused by the eye being or becoming too long 
from before backwards, like a telescope out of 
focus by being pulled out too far. Long sight is 
due to loss of power of focusing (accommoda- 
tion); the eye always remaining in its natural 
condition, focused for far sight. 

MYOPIA. 

(Short-Sightedness.) 
When the farthest distance at which ordinary 
type can be easily read is less than twelve inches, 
vision is short-sighted. Things close at hand can 
usually be seen well, but objects at a distance are 
dim, confused, and may be surrounded by circles 
of colors. Exposure to a bright light generally 
makes the sight worse. Short sight may be her- 
editary, may exist from birth, or be acquired by 
those who are occupied a long time at fine work, 

18 



274 Dr. J. Kean's Lectures. 

such as watchmakers and those who read or study 
much. 

Treatment. — Use concave glasses of as long 
focus as will suffice to read with ; and if there is 
much short-sightedness, a stronger glass for out- 
door use. The weaker glasses may be spectacles, 
with a stronger double eye-glass to be held in 
front of the spectacles for occasional distant 
vision. All stooping positions of the head must 
be avoided ; while reading the head should be 
thrown back, and the book brought to the eyes, 
not the eyes to the book. Avoid reading by gas- 
light, especially flickering light; the best arti- 
ficial light is a lamp with a shade throwing the 
light on the work, and leaving the rest of the 
room darkened. Avoid reading in a carriage, 
the jolting of which displaces the words, and 
tires out the eye by repeated focusing; for the 
same reason books printed in very short lines 
must be avoided. If the eyes grow tired, rest 
them, and do not begin work again till they are 
refreshed. When they are tired, or hot and irrit- 
able, bathe them with the lids shut, in cold water. 

PKESBYOPIA. 

(Long Sight.) 

This form is due to a failure of the focusing 

power of the eye, from weakness of the ciliary 

muscle, and is one of the first signs of advancing 

age, the muscles of the eye participating in the 



Long Sight. 275 

general degeneration of the whole system. The 
person affected notices that in order to read he 
has to hold the book farther off than he used to, 
though distant vision is unaffected. The failure 
of near sight is most noticed in the evening, the 
patient seeking a strong light to contract the 
pupil and render the vision clearer, by cutting off 
the outside rays in the same way that a dia- 
phragm is used between the lenses in a telescope. 

Treatment. — Convex glasses strong enough — 
that is, of short enough focus — to allow him to 
read easily at twelve inches from the eye, and a 
stronger glass for use in the evening. 

Hypermetropia — another form of long sight — is 
due to the eye being too short from before back- 
wards, or to changes in the lenses which the 
focusing power is only partially able to correct. 
This form of long sight may be either original or 
acquired, and is the reverse condition to short 
sight, the other form of long sight being merely 
failing power of one part of the eye. The sight 
for distant objects also may be confused in some 
cases. In order to see near objects, as in reading, 
the eyes are turned slightly inward and strongly 
focused. 

Treatment. — Is the same as for the other form 
of long sight, but after a time stronger glasses 
will be needed, owing to the eye relaxing from its 
state of permanent focus for short distance, by 
which it endeavored to compensate the defect. 



276 Dr. J. Kean's Lectures. 

This relaxation may be produced at once by two 
drops of solution of atropine, four grains to the 
ounce of water, and the strength of glass which 
will be ultimately needed ascertained. 

WEAK SIGHT 

May be due to the second form of long sight 
(hypermetropia). So long as the focusing power 
is sufficient to overcome the defect the sight is 
good, but the strain causes fatigue, and the focus- 
ing power relaxes, when the sight becomes dim 
and confused or disappears ; after a few minutes 
rest the sight returns, but if the work and strain 
on the eye continue, it soon disappears again. 
Another form of weak sight is due to fatigue of 
the muscle (rectus internus) which turns the eye 
inwards. After a short time, when reading, the 
letters become confused and the lines seem to 
overlap or run into one another. 

Treatment. — For the first form, proper glasses, 
as in long sight. The second form may require 
an operation to remedy it. 

ASTIGMATISM. 
(Uncertain Sight.) 
All eyes are slightly more curved in one direc- 
tion than in another, and when this is excessive, 
either from birth or caused by injuries or ulcera- 
tions, acuteness of vision is lost, each eye having 
two or more foci, one for each different curvature. 



Strabismus. 277 

If some thick lines be placed upright on a wall, 
and some more across beneath them, on walking 
slowly towards the lines, one group will be seen 
distinctly some distance before the other group 
appears clear and distinct, owing to the different 
diameters of the eye having different focuses, 
from their different curvatures. 

Treatment. — Cylindrical glasses of some kind, 
according to the character of the astigmatism. 

STRABISMUS. 

(Squinting.) 
When vision is sound and equal in both eyes, 
squinting may be cured by a minor operation. 

FUNCTIONAL DISEASES. 

NIGHT BLINDNESS 

Varies from dimness of vision to almost complete 
darkness after the sun goes down. It is most 
frequent in the tropics, and is caused by exposure 
of the eyes to a glare of light, in those who are 
weakly, especially from scurvy or malarious 
fevers. 

Treatment. — A plentiful supply of oranges, 
and four grains of quinine daily, with the use of 
dark neutral-tint glasses. 

COLOR-BLINDNESS 
Is quite consistent with perfect vision in other 
respects, and is usually present from birth, but 



278 Dr. J. Hearts Lectures. 

occasionally it may be produced by disease or in- 
jury. There are three varieties: 

1. Where no color is perceived, beyond black, 
grey and white, everything appearing like an en- 
graving, merely distinguished by the light and 
shade. 

2. Inability to distinguish shades of color. 

3. The most common form is that in which 
the sensation of red is wanting. 

The first form, or absence of all color sensation, 
is rare, and is usually produced by disease. 

The second form, inability to distinguish 
shades, may be acquired from over-use of the 
eyes in looking at colors, by color sorters. 

In the third form, the color they do not per- 
ceive is that of the lower end of the spectrum, 
red ; they see blue and yellow, with their combin- 
ations, but they see red and sea-green as grey, 
scarlet and green as yellow, rose color and blue- 
green as blue, while the different shades of red, 
and also of green, can be distinguished from each 
other. 

DISEASES OP THE EYELIDS. 

TINEA TAKSI 

(Inflammation of the Edge of the Lids) 

Is a chronic disease of the follicles of the eye- 
lashes which is difficult to cure and very apt to 
return. At first the margins of the lids are red 



Inflammation of the Edge of the Lids. 279 

and irritable; there is excessive secretion from 
the follicles of the eyelashes, which accumulates 
during the night and causes the lids to be 
gummed together in the morning. As the disease 
progresses the discharge becomes thick and pur- 
ulent and forms scales which adhere to the mar- 
gins of the lids and to the eyelashes. Small pus- 
tules form at the roots of the lashes, and burst, 
leaving small ulcerations covered by yellow 
crusts, the eyelashes gradually fall out and the 
edge of the lid becomes thickened, rounded, and 
turned outwards, causing a slight but constant 
overflow of tears in extreme cases. There is also 
considerable itching of the lids. This affection 
is most common among the poor and after acute 
fever, when the general health is lowered. 

Treatment. — Constant cleanliness. The lids 
must be bathed with warm water night and 
morning, and all scales removed. At bed-time 
the edges of the eyelids should be smeared with 
dilute zinc ointment, one part of ointment to seven 
of lard, and the lids washed in the morning with 
cold water, which may be repeated every three 
hours during the day. When the eyelashes are 
very long they should be cut short. In severe 
cases the edges of the lids may be touched in the 
morning with nitrate of silver solution, five grains 
to the ounce of water, applied with a camel-hair 
brush. The general health must be attended to ; 
milk diet, reduced iron, four grains twice a day. 



280 Dr. J. Kearts Lectures. 

HORDEOLUM 

(Sty) 
Is a small boil near the edge of the eyelid, gen- 
erally connected with one or more ej^elashes. A 
succession of them is a sign of ill-health. 

Treatment. — Hot fomentations and a poultice 
at night covered with a piece of oiled silk. The 
bowels may require to be open and tonics taken. 
30 grains compound rhubarb powder, as a purg- 
ative, and tincture of iron, 10 drops; quinine, 
2 grains, twice a day after meals, as a tonic in 
cases where there is a succession of sties. 
INVERTED EYELASHES. 

The eyelashes may be irregular, aflecting a few 
lashes or the whole row, or there may be a dis- 
tinct double row on the lid, the inner row turned 
inwards sometimes so completely that they can- 
not be seen till the lid is turned out. By the 
friction against the eyeball they cause severe 
irritation, and may render the cornea cloudy 
with red vessels running into it. 

Treatment. — Carefully transplant the eyelashes 
which are turned inwards, by an operation on the 
lid, which makes them grow natural (often per- 
formed by the author). 

Turning out of the edge of the eyelid, usually 
the result of an injury, and turning in of the edge, 
which may be spasmodic or a result of oph- 
thalmia, require an operation on the lids to 
. remedy them. 



B?*uises of the Eye. 281 

BRUISES. 
Commonly called a black eye. When the skin 
around the eye and the eyelids is puffed up with 
air, some of the bone-cells (ethmoidal or frontal), 
are broken; the patient should not blow his nose. 
Cold water should be applied to the bruised eye 
at once, and a cold lotion of half a drachm tinc- 
ture of arnica to an ounce of water used to wet a 
linen cloth, laid over the eye and remoistened 
from time to time. 



LEOTUKE VII. 

Affections of the Ear— Earache.— Inflammation of the 
External Ear. — Inflammation of the Inner Ear. — Run- 
ning from the Ear.— Bleeding from the Ear. 

AFFECTIONS OF THE EAR. 




Fig. 34.— The Ear. 

EARACHE. 

MAY be due to neuralgia, caused by a decay- 
ing* tooth, or to inflammation spreading up 
from the throat along the Eustachian tube, 
or to inflammation, or foreign bodies in the ex- 
ternal ear. 



Inflammation of External Ear and Drum. 283 

The pain may be very severe, sharp and piercing, 
darting out towards the ear or shooting from the 
ear over that side of the head and neck. 

Treatment. — Syringe out the ear with warm 
water, and then put in a plug of cotton soaked in 
equal parts of laudanum and glycerine ; apply a 
blister behind the aflected ear, and steam the 
throat by inhalation ; keep a bag filled with hot 
bran to the ear. 

INFLAMMATION OF THE EXTERNAL 
EAR AND DRUM. 

May be caused by cold, accumulation of hard 
wax, blows on the side of the head, irritating 
matters introduced into the ear, gout, etc. 

The symptoms are dull aching pain, which is 
increased on moving the jaw; diminished power 
of hearing, and at times temporary deafness 
from swelling of the membrane. The glands of 
the neck on the affected side become swollen; 
there is itching of the ear, and general depression 
and irritability. After two or three days a watery 
fluid begins to flow from the ear. The inflamma- 
tion may cause permanent diminution of hearing 
by thickening or relaxing the drum of the ear. 
Occasionally there is ulceration which perforates 
the drum, frequently causing total deafness of 
that ear. 

Treatment. — Improve the general health. 
Milk diet, quinine, iron. 



284 



Dr. J. Kearts Lectures. 



Hot fomentations and poultices to the ear, very 
gently syringing three times a day with warm 
water, in the interval one drop each of olive oil 
and laudanum with half a grain of acetate of 
lead. 

INFLAMMATION OF THE INNER EAR 

May be due to rheumatism, gout, scarlet fever, ' 
measles, or cold and scrofulous constitution. 
There is uneasiness in the ear, which is increased 
on blowing the nose or swallowing, and which 
gradually becomes a severe continuous pain, with 
[see Fig. 35] loud noises in the ear but deafness 




BAHliY 



Fig. 35.— Tinnitus Aurium. 

to external sounds. There may be severe head- 
ache, flushed face and eyes, sharp pains and a 
sense of bursting in the ear, anxious face, great 
depression, fever and delirium ; sometimes there 



Suppuration of the Em- 285 

is facial paralysis. The inflammation may sub- 
side or form pus, which bursts through the drum 
of the ear, giving instant relief, the opening in 
which usually soon heals, or the inflammation 
may spread into the cells of the bone. 

Treatment. — Hot fomentations and poultices 
(see neuralgia). If there is gout or rheumatism, 
its appropriate treatment. 

SUPPURATION 

(Running from the Ear) 
May be caused in children by teething ; in adults 
by cold, growths, fevers, especially scarlet fever 
and measles. The secretion is generally offensive 
and irritating, and may be tinged with blood. 
Usually the discharge stops in a short time, but 
it may become chronic and destroy the drum and 
small bones of the ear, and not unfrequently de- 
stroys a part of one of the bones of the skull 
(petrous of temporal), leading to inflammation or 
abscess of the brain. There may be no symp- 
toms beyond slight deafness. 

Treatment. — Frequent syringing, warm water 
alternately with milk and water, say every two 
hours. At night, cotton soaked in equal parts of 
olive oil, laudanum and acetate of lead solution. 

BLEEDING FROM THE EAR. 

When it follows blows on the head, it shows 
fracture of the base of the skull, and is a bad 



286 Dr. J. Kean's Lectures. 

sign. It may also be caused by wounds, foreign 
bodies [See Fig. 36], growths and death of bone; 
other causes are suppression of long-standing dis- 
charge, such as from an ulcer, and sudden rup- 
ture of the drum of the ear by violent coughing 
or sneezing. 




Fig. 36.— Foreign Bodies in the Ear. 

Treatment. — When the bleeding is from rup- 
ture of the drum, insert a plug of cotton steeped 
in equal parts of perchloride of iron and gly- 
cerine. Growths and obstinate deafness may 
be relieved by a good surgeon who is a graduate 
from a recognized college of otology. 



LECTUKE VIII. 

Diseases of the Cikculatory System — Inflammation of 
the Pericardium. — Diseases of the Valves and Hyper- 
trophy. — Breast-pang, or Angina Pectoris. — Palpita- 
tion.— Atheroma. — Aneurism. — Inflammation of Veins. 
—White or Milk Leg.— Varicose Veins.— Goitre.— Ex- 
ophthalmic Goitre. — Enlarged Spleen, or Ague-cake. 



DISEASES OF THE CIRCULATORY 

SYSTEM. 

THE heart is divided into four compartments, 
two collecting chambers, or auricles, and 
two pumping chambers, or ventricles. On 
the right side the right auricle collects the im- 
pure blood of the body from the great veins, and 
before every beat of the heart passes its blood 
into the right ventricle. At every beat of the 
heart, the right ventricle forces the blood in it 
into the vessels of the lungs, where the blood is 
purified, giving out chiefly carbonic acid gas and 
water. The veins from the lungs convey the 
purified blood to the left auricle, whence it is 
passed into the left ventricle, which at every 
stroke forces it into the great artery of the body 
to supply the system, from which it is returned 
by the veins to undergo the same round ; thus the 
right side of the heart receives the impure blood 



288 Dr. J. Kean y s Lectures. 

from the body, and forces it through the lungs, 
while the left side of the heart receives the puri- 
fied blood from the lungs and forces it through 
the body. The orifices of the arteries to the lungs, 
and to the body, and the passage between the 
auricles and the ventricles, are guarded by valves 
to prevent the blood flowing back from the arter- 
ies, when the pressure of the ventricles ceases, 
and from the ventricles during the stroke. The 
valves may be compared to folding doors which 
open only one way; they easily open forwards 
to the pressure of the blood, but slam together 
wfyen the blood tries to flow back. In the left 
half of the heart, which has most work to do, 
and is thickest in consequence, the valve is in 
two pieces and is termed the mitral. In the 
right half of the heart it is in three pieces, and 
is termed tricuspid. The valve of the great 
artery of the body is also in three pieces, and is 
termed aortic valve. The whole heart is enclosed 
in a fibrous bag, termed the pericardium, and is 
lined inside the chambers by a smooth inner 
lining, the endocardium. 

The position of the various parts of the heart 
on the chest is as follows : The apex or point is 
between the fifth and sixth ribs, about an inch to 
the inside of the nipple. The valve of the right 
side of the heart lies behind the centre of the 
breast-bone, where it joins the fourth rib. The 
valve of the left side (mitral) lies behind the point 



Diseases of the Circulatory System. 289 

of junction of the breast-bone and the fourth rib. 
The valve of the great artery of the body (aortic) 
lies behind the breast-bone, where it joins the 
third rib. The valve of the artery to the lungs 
lies close to the breast-bone, but not behind it, 
between the second and third ribs to the left side. 

There are few complaints which more surely 
tend to shorten life, and none give rise to greater 
suffering and discomfort, than diseases of the 
heart, pericardium, and great vessels. Alike in 
young and old they are the chief causes of sud- 
den death, and if not suddenly fatal, they lay 
their own hard conditions on the continuance of 
a man's life, and almost settle beforehand the 
manner of his death. 

The general symptoms which show disease of 
the heart are palpitation, sinking and fainting, at 
times along with difficult breathing, cough, pain, 
and tenderness. The breathing is panting or 
gasping, and oppression rather than tightness is 
complained of, with a strangling choking feeling 
at the throat ; it is made worse by movement, or 
by lying down, so that in severe cases the patient 
does not lie down for days, and should he sleep, 
he is at once awakened by a sense of suffocation, 
and has to struggle for breath. 

In many cases there is no breathlessness when 
at rest, but it appears with any sadden exertion, 
such as going up stairs. The diseases of the 
heart may be organic, when there is a change of 

19 



290 Dr. J. ICecon's Lectures. 

structure, or functional, when there may be no 
change. The organic diseases require training 
and an educated ear to distinguish them, so that 
it would be unavailable to the majority of readers 
of this work to fully describe the multiplicity of 
complications incident to the circulatory system, 
as such minuteness would only lead to confusion 
and uncertainty. The author will therefore treat 
rather superficially the subsequent part of this 
lecture, content to entertain consultation with 
those who desire further discussion on this most 
important division of the physiological system. 

It must not be supposed that all kinds of heart 
disease are rapidly fatal. Care may prolong life 
to an indefinite time. 

AFFECTIONS OF THE HEART. 

PERICARDITIS 
(Inflammation op the Pericardium) 

Is usually due to rheumatic fever, kidney disease, 
or scarlet fever. If there is an effusion of fluid 
between the membrane and the heart, there is 
difficult breathing and anxiety, the patient lying 
on his back and unwilling to move, the pulse is 
quick and there is pain and tenderness on pres- 
sure; if there is no fluid, pain is increased also 
by movement and breathing. 

Treatment. — Take fluid extract of digitalis, 1 
drop every two hours, aud saltpetre, 1 grain 



Inflammation and Fatty Heart. 291 

every intermediate hour. Hot fomentations; 1 
grain of opium every four hours. When chronic, 

Take 

Compound syrup of stillingia 4 oz. 

Iodide of potash % oz. 

Mix. 

Dose — Teaspoonful thrice daily. (See precau- 
tionary rules, Lecture XVII.) 

ENDOCARDITIS 

Causes discomfort and uneasiness at the heart, 
with various murmurs, and results from the same 
causes as pericarditis. (Treat the same.) 

INFLAMMATION OF THE HEART AND 
FATTY HEART 

Are distinguishable during life only by a skilled 
physician. 

DISEASE OF THE VALVES 

May be caused by endocarditis or by atheroma, 
which is a kind of fatty degeneration ; also from 
thickening and fibroid growths on the valves. 
The effect is either to narrow the passage for the 
blood (obstruction) or to prevent the edges of the 
valve segments meeting, thus allowing the blood 
to flow back (regurgitation). Obstruction and 
regurgitation of the aortic valve are compensated 
by enlargement of the left ventricle; regurgita- 
tion gives a peculiar pulse as if balls of blood 
were shot along the artery. Obstruction and re- 
gurgitation of the valve (mitral) of the left heart 



292 Dr. J. Kean's Lectures. 

prevent the blood passing quickly from the lungs 
by blocking the stream, and cause congestion of 
the lungs with severe cough, breath lessness, 
asthma and palpitations. When any form has 
existed some time it is apt to cause dropsy, begin- 
ning in the feet and lower eyelids. 

Treatment. — Nourishing diet, a small quantity 
of fluids and iron tonics — alternate with iodide 
of potash. 

HYPERTROPHY. 

Hypertrophy, or increased bulk of the heart, is 
a compensating growth to overcome some obstacle 
to the blood. The heart has a heaving motion 
and knocks against the ribs. 

ANGINA PECTORIS 
(Breast-Pang) 
Occurs generally after middle life, and is more 
common in men than women. It is of the nature 
of a neuralgia or spasm of a weak heart. The 
paroxysm occurs suddenly with intense pain 
about the heart, which may extend to the left 
shoulder, or even to the elbow or hand, often with 
a feeling of numbness. There is a feeling of suf- 
focation and a dreadful sense of impending death. 
The pulse is slow and feeble, the breathing short 
and hurried, the face pale and anxious, the sur- 
face of the body cold and covered with perspira- 
tion. The seizure rarely lasts more than one or 
two minutes, and when it passes off the patient 
often appears quite well. 



Palpitation. 293 

During an attack, if the patient is walking he 
is obliged to stop, but consciousness is unimpaired. 
If the patient does not die during the first attack, 
he generally dies of some subsequent one. The 
intervals between the attacks vary from a few 
hours to months. 

Active exercise, such as ascending a stair 
quickly, or strong mental emotions, a frightful 
dream, or considerable flatulence, are all exciting 
causes ; each repetition of an attack increases its 
tendency to return, and also increases its violence. 

Treatment. — During the attack, inhale nitrite 
of amyl, two to five drops at a time ; two teaspoon- 
fuls of brandy, a hot foot-bath. If the attack is 
prolonged, a compound colocynth pill, and a 
mustard poultice for ten minutes to the abdomen. 

During the interval nourishing food and tonics, 
such as carbonate of iron and quinine 1 grain of 
each twice a day, along with iodide of potassium 
4 grains once a day. As in all diseases of the 
heart, quietness of body and mind is most im- 
portant. 

PALPITATION 

Means inordinate action of the heart, and may 
be produced from many causes. Temporarily by 
any sudden or violent emotion, such as fright, joy, 
or anxiety; but unless continuous or very fre- 
quent, such an effect is not called palpitation. 
The more common causes are from disease of the 



294 Dr. J. Ream? 8 Lectures. 

heart, from indigestion, or from the nervous sys- 
tem by abuse of strong tea, tobacco, spirituous 
liquors, intense study, want of sleep, or sedentary 
habits, and also from changes in the blood, as in 
gout, jaundice, Bright's disease, or bloodlessness 
(anseinia). 

The attack of palpitation may be sudden or 
only at night, or it may be preceded by acidity, 
flatulence, or some other affection of the stomach. 

Treatment. — During the attack let the patient 
lie flat on his back, with the neck and chest bare, 
allowing the air to blow freely over it ; and take 
2 ounces of camphor water, along with 30 
drops of ether, which may be repeated every 
half-hour till the attack subsides. Afterwards 
pay attention to the food and general health, 
avoid tea and coffee, and take cold water or 
boiled milk instead, moderate exercise in the 
open air, avoid tight clothing, use a cold shower 
bath if it can be borne ; and if there is bloodless- 
ness take of carbonate of iron 4 grains twice a day. 

DISEASES OF THE BLOOD VESSELS. 

ATHEROMA. 

(Pulpy Encysted Tumor.) 

Arteries are composed of thin layers of an outer 

fibrous coat, a middle muscular and elastic coat, 

and an inner brittle coat. They are subject to a 

chronic affection called atheroma, which begins 

in the deeper layers of the inner coat, as a soft, 



Atlieroma. 295 

transparent jelly, occurring in little flat patches, 
and which degenerates and finally eats through 
the lining membrane of the artery, forming an 
atheromatous ulcer. Lime salts are also depos- 
ited in the inner coat extending from the deeper 
layers to the inside free surface, forming scales in 
the large arteries and solid tubes in the smaller 
arteries. The result of these changes is that the 
small arteries are narrowed or blocked up by the 
new material while the large arteries are in- 
creased in size from their elasticity being de- 
stroyed. The current of blood is slowed by the 
rough surface of the lining membrane, the want 
of elasticity, and the narrowing of small arteries, 
and may form clots, which may block up the 
vessel. The scales formed of the lime salts, or 
clots formed, may be washed away in the cur- 
rent of blood and block up smaller distant 
arteries, causing apoplexy if in the brain, and 
death of the part supplied with blood from that 
arteiy. This is the most common cause of gan- 
grene (mortification) of the toes in aged people. 
The arteries at the wrist and on the temple may 
be seen and felt to be hard and tortuous in many 
elderly people, which is caused by atheroma, and 
also a white ring round the clear space or cornea 
of the eye (arcus senilis) 

There are no special symptoms and the treat- 
ment is limited to nourishing food and avoidaDce 
of sudden excitement or exertion. The parts 



296 Br. J. Kean's Lectures. 

already injured cannot be restored, but the dis- 
ease is not incompatible with a long life. 

ANEURISM 

Is a swelling on an artery forming a pulsating 
tumor, and may occur when an artery is weak- 
ened by thinning of its walls or by atheroma. It 
is commonly formed of the inner and outer coats 
of the artery dilated in one spot into a bag, which 
slowly increases, the inner coat disappearing, and 
which converts any organ it touches into a part 
of the sac till it reaches a free surface such as 
the skin or bowels, when it bursts and causes 
death from bleeding. Where an aneurism, how- 
ever small, projects into a mucous canal, such as 
any of the ducts or air passages of the body, it 
softens and ruptures. Aneurism of part of the 
great artery (aorta) may cause cough, extreme 
breathlessness, or asthma, croaking voice, and 
difficulty of swallowing, from pressing on a 
branch of the nerve to the lungs (recurrent 
laryngeal). 

Treatment. — The object of the treatment is to 
slow the current of blood, so that the sac of the 
aneurism may become filled up with a clot, 
which thus obliterates the aneurism and causes a 
permanent cure. Aneurisms of the limbs and 
branches of the main artery may generally be 
cured by a surgical operation, provided the arter- 
ies generally are healthy. The medical treat- 



Phlebitis. 297 

ment of aneurisms inaccessible to the surgeon, 
consists of strict rest, lying down in a cheerful, 
airy room. On no account must the patient stand 
or even sit up. 
Moderate diet ; all excitement to be avoided. 

Take 

Tincture of aconite 3€ oz - 

Tincture of Veratrum viride % drachm. 

Acetate of potash 1 drachm. 

Iodide of potassium y 2 drachm. 

Elixir of taraxacum 4 oz. 

Mix. 

Dose — One teaspoonful, in water, three times 
a day between meals. (See precautionary rules. 
Lecture XVII.) 
The pain may require to be soothed by opiates. 

PHLEBITIS 

(Inflammation of the Veins) 

Is of two kinds, or rather the effects are of two 
kinds. 1. Adhesive, where a clot is formed which 
may fill the vein and cause its obliteration, leav- 
ing the part affected as a fibrous cord, or it 
may be dislodged and be carried in the blood 
through the heart to the lungs, where it blocks 
up some vessel, causing sudden breathlessness 
and other symptoms of apoplexy of the lungs. 
2. Suppurative, in which it forms pus or absorbs 
it from some sore, and the particles being small 
enough to pass through the lungs are caught in 
distant organs, and when the pus is infective it 



298 Dr. J. Keari's Lectures. 

sets up an abscess wherever it is caught : hence 
the multiple abscesses in pyaemia which occur in 
the lungs, limbs, and body generally. Bed-sores 
are not an unfrequent cause of clots in the veins. 

Symptoms.— There is pain, increased on pres- 
sure, swelling, stiffness and redness over the 
affected vessels, and generally spreading up- 
wards towards the heart. When suppuration 
occurs there are flying pains in various parts of 
the body, generally accompanied by fever. 

Treatment. — Perfect rest, hot poultices, milk, 
eggs, six tablespoonfuls of sherry daily, with 
quinine four grains. 

PHLEGMATIA DOLENS 
' (Milk Leg) 
Is a painful, brawny swelling of one or both 
lower limbs, and is most common in women 
within six weeks after confinement, especially 
when much blood has been lost. The symptoms 
are due to obstruction of the veins and lymph- 
atics by a clot. The disease may begin with a 
chill or shivering, succeeded by a fever, head- 
ache, thirst, sickness and pain, especially in the 
lower part of the abdomen. Within twenty-four 
or thirty-six hours swelling of one or both limbs 
appears, the left leg most frequently. The limb 
is hot, tender, swollen perhaps to twice its ordin- 
ary size, of a pale white color, and glazed appear- 
ance, tense and elastic, the large vein rolling 



Phlegm atia Dolem. 299 

under the finger like a cord. The acute stage 
lasts from two to three weeks, but the limb may 
remain swollen for weeks after the acute symp- 
toms subside, and may be useless for months or 
never recover its former power and shape. 

Treatment. — In the acute stage, perfect rest, 
simple diet, warm cloth slightly coated with 
solid extract of belladonna, applied to calf and 
partially up the thigh ; if necessary, continue for 
twelve hours, if longer, use sparingly ; its use 
should be discontinued if pupils dilate or the 
face becomes flushed. (Its application should be 
with great caution or by a person skilled in the 
administration of medicine.) Or hot fomentations, 
1 pound of bicarbonate of soda and 2 drachms 
extract of opium to a gallon of boiling water. 
The flannel should be wrung out and applied to 
the tender parts every half-hour or oftener, and 
should be covered with a piece of waterproof 
gutta-percha tissue or oiled silk. Two glasses of 
sherry daily along with boiled milk, 2 grains 
each of quinine and iodide of potassium twice 
daily. In the chronic stage, bandaging, change of 
air. Friction with ammonia liniment ; 10 drops 
of the perchloride of iron in water twice daily, 
before breakfast and dinner. 

VARICOSE VEINS 

Is a swelling of the veins next the skin, often 
looking like knotted cords, and of a dull leaden 



300 Dr. J. KearCs Lectures. 

or purplish color. It usually occurs in the veins 
of the nether limbs, and a predisposition to it is 
often hereditary. It causes severe aching pain 
after long standing in one position. A vein may 
burst, causing dangerous bleeding, or a painful 
ulcer may form. The causes are long-continued 
standing in one position, constipation, or any- 
thing which presses on the veins and prevents 
the return of blood. The weight of the column 
of blood when standing dilates the vein, and the 
valves are usually burst. 

Treatment. — The leg well washed and rubbed 
dry every day. Canvas stockings, lacing like a 
pair of corsets, or flannel bandaging, to give sup- 
port to the weak veins. Elastic stockings are 
best for those who can afford to get frequent new 
pairs, for the elastic soon becomes slack and does 
not give proper support. Avoid standing ; either 
walk, or sit down with the limb raised. 

DISEASES OF THE BLOOD GLANDS. 
GOITRE 
(Wry Neck) 
Is an enlargement of the thyroid gland, one half 
of which lies on each side of the windpipe and 
connected by a bridge of gland substance across 
the windpipe. It attacks women very much more 
frequently than men, and is seldom seen before 
puberty. At first the gland is soft, but as it en- 
larges it becomes firm and hard, but causes no 



Goitre. 301 

pain nor discomfort till it becomes so large as to 
interfere with swallowing or breathing. The 
right lobe is usually larger than the left, but 
sometimes the distinction between the lobes is 
lost. It prevails most in certain districts; the 
drinking water is popularly supposed to be the 
cause, but this is by no means proved yet. 

TREATMENT. 

Take 

Iodine 10 grains. 

Iodide of potassium 20 grains. 

Distilled or rain water 20 ounces. 

Mix. 

Dose — One teaspoonful twice a day, after break- 
fast and dinner, add a teaspoonful to the dose 
every week till six teaspoonfuls are taken for a 
dose. Paint with collodion every second night, 
wash off next morning ; or rub a small piece of 
compound iodine ointment on the swelling night 
and morning. When the breathing is much in- 
terfered with, the gland may be removed. 

EXOPHTHALMIC GOITRE 

Is the name given to a combination of palpitation 
with protrusion of the eyes and enlargement of 
the thyroid gland. It is rare in children, and is 
more common in women than in men. It accom- 
panies or follows wasting discharges, and is 
sometimes associated with heart disease. Palpi- 
tation is long continued, with a quick pulse, 120 
to 140, and whistling sound in the thyroid gland, 




Fig. 37.— Consultation. 



Exophthalmic Goitre. 303 

giving a peculiar sensation to the hand. The 
disease is usually chronic and continues for 
months or years, the patient becoming dropsical 
and breathless, but usually ending in recovery. 

TREATMENT. 

Take 

Tincture of digitalis 2 drachms. 

Fluid extract of belladonna 1 drachm. 

Acetate of potash 1% drachms. 

Carbonate of iron 1 drachm. 

Crystal drips 1 oz. 

Water 3 oz. 

Mix. 

Dose — One teaspoonful thrice daily before 
meals (see precautionary rules, Lecture XVII). 

Small doses, such as the % grain of the acetate 
of morphia, may be required to obtain sleep. 

INFLAMED SPLEEN 
(Ague-Cake) 
Occurs chiefly from repeated attacks of malarial 
fever. The spleen may be enormously enlarged, 
causing a sensation of weight and uneasiness; 
the face is sallow, the body wasted, diarrhoea, or 
hemorrhage, often profuse, from the bowels, and 
dropsy of the feet, the patient being greatly 
exhausted. [See Fig. 37.] 

TREATMENT. 

Iodide of potassium 30 grains. 

Carbonate of iron 20 grains. 

Mix. 

Make ten powders. 

Dose — One powder twice a day, compound • 
iodide ointment to be rubbed over the spleen. 



LECTUEE IX. 

Diseases of the Air Passages — Catarrh. — Ozena.— 
Bleeding from the Nose. — Sore Throat. — Ulcers and 
Dropsy of the Windpipe ((Edema Glottidis). — Croup. 
—Hay Asthma.— Bronchitis (acute and chronic).— Bron- 
chiectasis. — Asthma. — Emphysema. — Bleeding from 
the Lungs, or Hemoptysis. — Pneumonia. — Consump- 
tion. — Pleurisy (acute and chronic). 



DISEASES OF THE AIR PASSAGES. 

CATARRH. 

(Cold in the Head.) 

INFLAMMATION and swelling of the mucous 
membranes, which are the membranes lining 
the air passages and ducts of the body, is called 
catarrh, and receives different names according 
to the part affected. In the nose it is called 
coryza, in the lungs bronchitis, and so on ; but it 
is usually understood of the nose and throat. 

The causes of catarrh are various, and the lia- 
bility to it varies much in different people when 
exposed to the same cause : the part affected also 
differs. Thus, what in one almost always gives 
rise to a cold in the head, may cause in another 
cold in the throat, and fin a third diarrhoea, from 
affecting the mucous lining of the bowels. After 
repeated attacks the membrane wherever situated 



Catarrh. 305 

becomes weakened and more easily inflamed. 
Badly nourished people, those of weakly consti- 
tution, and those of sedentary habits are more 
easily affected than strong people who are much 
out of doors. 

By far the most frequent cause of all catarrhs, 
excepting of the stomach and bowels, is chilling 
of the skin, generally by exposure to draughts of 
cold air when the body is cooling after being 
heated, or by damp feet. A cold is more easily 
taken after fatigue, when the system is not able 
to react or resist so powerfully, and when cooling 
after exertion from the comparatively large 
amount of perspiration which is passing insensi- 
bly as vapor, and carrying ofl the heat. When a 
part only of the skin is exposed to the cold, it is 
more apt to cause catarrh than if the whole body 
were exposed, as by insufficient clothing, etc. 
Long standing or sitting on cold stones and damp 
feet are other common causes. Damp feet or 
clothing is more prejudicial than thoroughly wet 
clothing, from its abstracting more heat; the 
damp is sent ofl* in vapor abstracting a large 
amount of heat, and after getting chilled, it may 
fall again inside, the shoes or dress acting as a 
carrier of heat, while with thoroughly wet cloth- 
ing the body is unable to vaporize it, and a layer 
of warmed water is left next the cuticle. For 
this reason, in bathing, the skin should be thor- 
oughly dried. 

20 



306 Dr. J. Kearts Lectures. 

Other causes of catarrh are the direct action of 
irritant substances, such as breathing very cold 
air, dust, or acrid vapors, extension of previous 
inflammation ; thus a cold in the throat tends to 
spread to the lungs, blood poisoning, such as oc- 
curs in measles, and, lastly, morbid growths or 
ulcers. 

The symptoms of a cold in the head, which in 
a minor degree are familiar to everyone, are a 
feeling of languor and general weakness, pains 
in the limbs, aching in the back, a sense of tight- 
ness and feeling of weight in the head, sneezing, 
watery eyes, obstruction of one or both nostrils, 
with excessive thin colorless discharge, which 
often becomes acrid and irritating, and is fol- 
lowed by dryness, tenderness, and swelling, 
hoarseness, sore throat, nasal voice, perverted 
taste and smell, furred tongue, flushes of heat, 
feverishness, loss of appetite, quick pulse, at 
times shivering and an eruption of herpes at the 
corners of the lips. 

At the end of forty-eight hours the symptoms 
begin to abate, or pass into a more severe affec- 
tion, such as quinsy, bronchitis, pneumonia, etc. 

Treatment. — When produced by cold to the 
skin, within the first six hours warmth to the 
same part of the skin generally stops it, thus 
when from cold feet, a hot foot-bath or a hot bot- 
tle for half an hour suffices. For cold in the 
head a large dose of morphia, such as % of a 



Ozcma. 307 

grain while the cold is approaching, prevents it 
by arresting the reflex nervous action, but once 
inflamed, stopping the reflex action is no long- 
er sufficient. The last state may be worse than 
the first. An agreeable treatment for slight colds 
is a Turkish bath. Free perspiration, no matter 
how induced, generally by hot drinks, or solution 
of acetate of ammonia, a teaspoonful every two 
hours, may be used, and abundant bedclothes are 
the most common and one of the best treatments 
for all colds. Apply to the upper lip grease, to 
prevent the acrid discharge irritating it. Snufl 
of morphia, bismuth, and gum-acacia, I consider 
the best remedy, if applied with rubber blower by 
way of posterior naries — behind the nose — (see 
Gray's- xAjiatomy), or chlorate of potash solution. 
To prevent colds, the neck and chest should be 
sponged with cold water daily, and damp feet 
carefully avoided. 

OZ^NA 
Is a chronic inflammation of the nostrils, which 
may be due to long-continued attacks of catarrh, 
especially in scrofulous people. It is an extreme- 
ly obstinate complaint, often continuing for years 
with varying intensity. The symptoms are those 
of a common cold, uneasiness and stuffiness of 
the nose, headache, and very foetid discharge, 
generally profuse, forming crusts of stony hard- 
ness which are expelled on blowing the nose. 
When there are ulcers, the adherence of the mem- 



308 Dr. J. Kean's Lectures. 

brane to the bone and irritation from constantly 
blowing the nose prevent their healing. The 
swelling of the mucous membrane narrows the 
nostrils, and favors the putrefaction of the 
secretion. 

Treatment. — Principally the general health, 
quinine and iron. 

Take 

Quinine 20 grains. 

Reduced iron 60 grains. 

Mix. 

Make sixty powders. 

Dose — One, three times daily. Locally frequent 
syringing with solution of permanganate of pot- 
ash, one grain to two ounces of warm water. A 
snuff of chlorate of potash 30 grains, sugar half 
an ounce, may be used. 

EPISTAXIS. 

(Bleeding from the Nose) 

Is most common in youth, and may arise without 

any well-defined cause or from injuries, fever, or 

obstructed circulatiQn. 

Treatment. — Avoid snuffling and wiping the 
nose, which tend to aggravate the flow, put some- 
thing cold to back of neck and down the spine. 
Hold both arms straight above the head for three 
minutes, avoid hot drinks, and take a tablespoon- 
ful of vinegar, repeated in ten minutes if required. 
If these means do not succeed, plug the affected 
nostril in front with a piece of lint ; and if it still 



Laryngitis. 309 

bleeds from behind, an attempt may be made to 
plug the nostrils on both sides. Pass a loop of 
thin wire through the nostril till it is seen in the 
throat, tie to the loop brought out at the mouth 
one end of a tape in the centre of which is 
securely tied a piece of lint of the size of a 
hickory nut, pull back the wire through the nos- 
tril, drawing the tape after it, pull the tape till 
the lint blocks the nostril behind, then tie the 
ends of the tape coming from the mouth and nose 
together, and plug the nostrils in front; after two 
days the plug may be withdrawn by pulling the 
tape coming through the mouth. 

LARYNGITIS. 

(Sore Throat.) 

Sore throat depending on inflammation of the 
windpipe may be produced by extension of in- 
flammation from the throat, from inhaling acrid 
vapors or dust, chilling of the skin, or prolonged 
singing, the altered or lost voice being due to the 
swelling of mucous membrane altering the density 
of the vocal cords. This form (sub-acute) usually 
subsides spontaneously, or it may require treat- 
ment, or become chronic. 

In chronic inflammation the voice is hoarse, 
harsh, and cracked, or even quite lost ; there is 
often a tickling cough, with a frequent desire to 
clear the throat, and expectoration of mucus; 
occasionally there is slight difficulty of breathing. 



310 Dr. J. Keari's Lectures. 

Acute inflammation commences like a slight 
cold and is rapidly followed by fever, redness 
of the back of the throat, and a feeling of burn- 
ing or soreness which is made worse by speaking 
or coughing, difficulty of swallowing, more with 
liquids than with solids. Hoarse voice, which 
suddenly cracks or breaks into discord when 
exerted, owing to the swollen vocal cords touch- 
ing each other, raising the tone ; after a little time 
the voice is reduced to a husky whisper, or is 
completely lost. There is a violent cough, at 
first clear and shrill, soon becoming harsh, and 
often begins and ends with a hissing sound, and 
after a time is lost. Breathing is usually difficult, 
from the first a peculiar sound like a whisper 
accompanying both expiration and inspiration. 
Inspiration is prolonged, laborious, wheezing, 
piping, and starts sharp from the previous expira- 
tion. Paroxysms of breathlessness occur, during 
which the face is flushed, the eyes protrude, the 
pulse is hard and quick, and there is great general 
distress; the windpipe moves rapidly up and 
down, the chest heaves, and the patient gasps for 
breath. 

In children, attacks of breathlessness occur 
chiefly at night ; there may be no symptoms be- 
yond cough and hoarseness in the daytime, but 
at night the child awakes suddenly with great 
oppression of breathing, verging on suffocation, 
and a hoarse barking cough, which is due to the 



Laryngitis. 311 

secretion accumulating on the vocal cords during 
sleep, as it does on the eyelids in chronic inflam- 
mation of the lids. The expectoration is at first 
clear and glairy, but scanty or even absent, and 
as the disease progresses and begins to abate, it 
becomes thicker and yellow. 

In acute cases the disease usually terminates 
by recovery in about a week, the hoarseness and 
cough abating, or it may relapse several times or 
become chronic, which frequently continues for 
years. 

Treatment. — In acute inflammation, warmth 
and rest. Restrain the cough as much as possible ; 
each cough is a fresh irritation to the inflamed 
surface. The air of the room should be kept 
moist and at a temperature of 70° F. A hot cloth 
saturated with a weak solution of belladonna 
applied round the throat, extending to the ears. 
Inhalation of steam every half hour for two 
minutes at a time ; if there is violent coughing, 
2 drops of chloroform may be added to the hot 
water for inhalation. In a strong person, a cold 
water compress covered with dry bandages is at 
times preferable to hot fomentation or poultices. 
In the form occurring at night in children, a 
sponge dipped in water as hot as can be borne 
applied to the throat and frequently renewed, 
along with gelsemium 2 drops every hour. 

In chronic inflammation, inhalation of steam 
three times a day, containing 3 grains of gallic 



312 Dr. J. K earn? s Lectures. 

acid and 10 drops of laudanum to the ounce twice 
a day, or belladonna, as in the acute. 

ULCERS AND DROPSY OF THE WIND- 
PIPE. 

Besides ulcers produced from the pustules of 
small pox and in measles and typhoid fever, the 
top of the windpipe is liable to ulcers from 
chronic inflammation of the mucous membrane, 
and especially as a complication of consumption. 
The symptoms are much the same as those of 
chronic inflammation, with more tendency to 
variation, better one day and worse the next. 
When there is fever, loss of flesh and night 
sweats, consumption should be suspected. 

The treatment is the same as that of chronic 
inflammation ; ulcers of fevers usually disappear 
of themselves as the fever passes off. Dropsy of 
the upper part of the windpipe (glottis and epi- 
glottic folds, mdema glottidis) takes place very 
easily, just as we see in the eyelid, and from the 
same cause, the loose submucous tissue opposing 
little or no resistance. The symptoms are some- 
what like those of croup, there is rapidly increas- 
ing hoarseness or loss of voice, a harsh barking 
cough and difficulty of swallowing; along with 
these symptoms there is alarming breathlessness. 
During inspiration the swellings are drawn over 
the top of the windpipe, causing loud, loDg-drawn, 
' forced, sharp, noisy whizzing or hissing breath- 
ing, while expiration is tolerably easy and inaud- 



Crovp. 313 

ible, there being little obstruction to the air 
going out, as it forces aside the swellings just as 
inspiration draws them together. Along with the 
difficulty of breathing, there is a feeling of a 
foreign body in the throat, which causes choking. 
Treatment. — Very hot fomentations of bella- 
donna to the neck, and — 

Take 

Tincture of aconite 12 drops. 

Tincture of gelsemium 12 drops. 

Water 1 oz. 

Mix. 

Dose — One teaspoonful every two hours for 
twelve hours, followed by 

Take 

Tincture of belladonna 20 drops. 

Syrup of prunus virginiana 2 oz. 

Mix. 

Dose — One teaspoonful thrice daily. (See pre- 
cautionary rules, Lecture XVII.) 

An operation (laryngotomy) to open the wind- 
pipe should be performed, in cases of urgency, 
by a surgeon of reputed skill, who is a graduate 
of some recognized college of medicine and 
surgery. 

The air of the room must then be kept warm, 
at 70° F., and moist, as there is a great tendency 
to inflammation of the lungs. 

CROUP 

Is a non-infectious inflammation of the mucous 
membrane of the windpipe, occurring in chil- 
dren chiefly from the second to the seventh year, 



314 Dr. J. Kean's Lectures. 

or from the first to the second time of teething. 
Like diphtheria, a false membrane is formed in 
the windpipe, but it merely lies on the true mem- 
brane, and when it is removed there is no loss of 
substance, while in diphtheria the membrane is 
deposited in the true membrane, and when re- 
moved leaves a raw bleeding surface with a loss 
of substance, leaving a scar. Croup attacks boys 
more frequently than girls, and those of weakly 
constitutions more than the robust. It prevails 
most in low-lying damp situations exposed to the 
east wind. The approach of croup is generally 
gradual ; a very violent primary stage being the 
exception. The first symptoms are a general 
feverishness and fretfulness of the child, with 
some peculiarity in the voice, which becomes 
somewhat harsh, or slight hoarseness occurs, 
accompanied by a short cough and a feeling of 
pain in the throat, or in an infant it raises its 
hand to its throat. After a variable time, usually 
about eighteen hours, the formidable symptoms 
of an attack of croup appear, almost always be- 
ginning during the night or in the evening. The 
child is greatly alarmed, the face is red and 
flushed, the veins in the head and neck distended, 
the voice and cry are shrill and piping, and the 
cough, which was sharp, short and barking, be- 
comes hoarse, harsh and clanging. The voice 
and cough may gradually be lost; we see the 
child cough or speak, but do not hear it. Besides 



Croup. 315 

these, the characteristic symptoms of croup, per- 
sistent, perilous difficulty of breathing appears, 
which continues increasing, and is accompanied 
by a peculiar loud, sonorous piping noise. The 
breathing is exceedingly laborious, the child sit- 
ting up to give the muscles full play, and the 
lower part of the chest being drawn in by its 
efforts. With all this difficulty of breathing, 
there is no real difficulty of swallowing; if 
allowed to choose its own time, the child will 
readily swallow anything given it. 

After a time the cough, which at first was un- 
attended with expectoration, brings up whitish 
shreds of membrane which cause increased diffi- 
culty of breathing while being coughed up, but 
leave it easier for some time afterwards. If the 
back of the throat about the tonsils be examined, 
it will be seen to be lined with white membrane. 
There is increased fever with hot skin, thirst, de- 
pression, restlessness, and weak, quick, irregular 
pulse. If the child is not suffocated, the disease 
remits toward morning, the cough loses its twang, 
and the crowing inspiratioDS lessen or cease, the 
fever abates, the voice and sound of the cough re- 
turn, and except the piping tone of voice and 
hoarseness of the cough, there may be no signs of 
the previous night's scene of terror, but the com- 
ing night may bring a repetition of the attack, 
even worse than the former, and especially is 
this to be dreaded if the fever continues during 




Fig. 38.— Croup. 



Croup. 317 

the day, and there is a false membrane in the 
throat. Sometimes the remission in the morning 
fails to appear, the disease running a continuous 
course, and in such cases it is generally fatal. 
When approaching final dissolution, which is 
either by insensibility or suffocation [see Fig. 38], 
or after protracted attacks by exhaustion from in- 
sensibility, death is comparatively slow, the flush- 
ed face becoming pale, the anxiously gazing eye 
becomes dim, increasing drowsiness, but not 
proper sleep, the child being uneasy and starting 
in terror, the breathing is gasping, but loses the 
crowing sound ; if the child tries to take a long 
breath it brings on a fit of suffocation, during 
which it starts up and makes violent efforts to 
breathe, and finally sinks back exhausted ; the 
breathing is quick and short ; after a time the suc- 
cessive paroxysms of difficult breathing fail to 
rouse it, the skin being cold and clammy with 
perspiration, the pulse small and thready, there 
may be convulsions, insensibility becomes com- 
plete, and in this state it passes away. Though 
there is an apparent struggle at the close, there is 
no suffering, the blood-poisoning by the retained 
carbonic acid destroying sensation like chloro- 
form. When it dies from direct suffocation, its 
last minutes are spent in an uneasy, often violent 
struggle for breath, which is painful to witness. 
The total duration of an attack of croup varies 
from three to twelve days, but the great majority 



318 Dr. J. OCean's Lectures. 

last from four to six days, and are at their height 
about the third day with white tongue, hot skin, 
quick pulse, flushed, anxious face, and crowing 
breathing. Though well-marked croup and 
diphtheria are very different, yet they approach 
each other till in some cases it is almost impos- 
sible to distinguish one from the other. The im- 
portant practical difference is that diphtheria is 
infectious, while croup is not, although it is not 
improbable that both may be got from emana- 
tions from sewers and drains. A form of diph- 
theritic sore throat which is epidemic is due to 
defective drainage. Croup is more apt to occur 
with a child which has had a previous attack, 
and all the children of one family often show a 
remarkable predisposition to it ; so where one 
child has been affected, great care should be taken 
of the others till they are twelve years of age. 

Treatment. — Confinement to bed in a room 
kept at the temperature of 70° F. day and night, 
and the air kept moist by pouring steam into the 
room. Keep the head higher than the body to 
favor breathing, let the child wear a flannel dress, 
but avoid all tight clothing, let it drink freely of 
water, milk, and barley-water ; apply the follow- 
ing to the throat and chest, to remove the pain : 
Take 

Olive oil 2 oz. 

Spirits turpentine % oz. 

Mix. 



Lungs and Air Passages. 319 

Take 

Tincture of aconite, 2 drops in a little water, 
internally, every two hours. 
Take 

Acetic tincture of lobelia 1 oz. 

Acetic tincture of sanguinaria % oz - 

Crystal drips lj| oz. 

Mix. 

Ijose — Half to one teaspoonful every half hour, 
this will promote expectoration. Do not vomit 
the patient. Apply with atomizer weak solution 
of baptisia tinctoria. 

When an attack comes on, place the child in a 
warm bath for ten minutes. If there is no im- 
provement in twelve hours, tracheotomy (opening 
the windpipe) should be performed by the nearest 
efficient surgeon, thus protecting the child from 
suffocation while the above remedies act. How- 
ever well the child appears, it should always be 
watched at night, and not let out of the house for 
a period of two weeks after an attack. 

THE LUNGS. 
The lungs are two large, light, spongy bodies 
of a conical shape, filling the upper part of the 
chest above the midriff (diaphragm), or muscular 
partition between the chest and abdomen, and 
having the heart between them. The tops of the 
lungs begin in the neck about an inch above the 
collarbone, and touch each other in the middle 
line between the first and second ribs ; they con- 
tinue touching till they reach the level of the 
fourth rib, when they begin to separate, allowing 



320 Dr. J. Rearis Lectures. 

a part of the heart to come in front. The base 
of the lungs is hollowed out to receive on the 
right side the projection of the liver, which rises 
as high as the fifth rib, and on the left side the 
lung is less hollowed to receive the stomach and 
spleen, which rise as high as the sixth rib. Both 
lungs extend much lower down behind than in 
front, the left being the lowest, and extending 




Fig 39.— Internal Organs. 
below the (twelfth dorsal vertebra) level of the 
last rib. The right lung is shorter and thicker 
than the left, overlapping the liver and reaching 
down to the sixth rib in front. It is divided into 
three lobes, which correspond to the first divisions 
of its branch of the windpipe. 



Lungs and Air Passages. 321 

The left lung is longer and narrower from the 
heart being chiefly on its side [see Fig. 39], and 
reaches to the seventh rib in front. It is divided 
into two lobes, corresponding to the first divisions 
of its branch of the windpipe. 

Taking a breath or a permanent state of inspi- 
ration by expanding the lungs causes the tops to 
rise higher and the bases to descend lower, and a 
longer part of the two lungs to touch, while expir- 
ation reverses this, the difference in length of the 
lungs between the two states being an inch to an 
inch and a half. 

The lungs are composed of a number of air 
vessels or bronchi, branching like the branches 
of a thick tree till they end each twig in minute 
air cells or vesicles formed of a tough membrane, 
which is lined outside by a very close network 
of blood vessels. Between the air vessels or 
bronchi are connective and elastic tissue, blood 
vessels, lymphatic vessels, and glands, forming 
the lung substance. The larger air vessels or 
bronchi are composed of cartilaginous rings, 
something like the windpipe, with circular mus- 
cular fibres and elastic tissue, the whole lined 
inside with a smooth, tough membrane, but in 
the smallest bronchi and in the air vesicles the 
membrane alone is left. 

Outside, each lung is lined with a smooth, 
shining, serous membrane, called the pleura, 
which after lining the lung goes round the inside 



322 Dr. J. Kean's Lectures. 

of the chest, lining the cavity in which the lung 
is situated. Thus the contiguous surfaces of the 
lung and of the chest wall are alike coated by the 
same slippery membrane, and friction is mini- 
mized. In pleurisy a quantity of fluid may separ- 
ate the lung from the chest walls, but to make 
room for the fluid the volume of the lung must 
be diminished by compression. The function of 
the lungs is to supply oxygen to combine 
with the tissues or products of the food, in 
order to supply heat and power of work 
or energy to the body (see Chlorosis), and also 
to get rid of waste products of burnt tissue in 
the shape of carbonic acid and water. In order 
to do this the air vesicles of the lungs present a 
surface estimated as thirty times as much as the 
surface of the skin, where the impure blood from 
the right side of the heart gives off carbonic acid 
into the air and takes in oxygen by the red blood 
corpuscles, which give it off again where it is re- 
quired in the tissues. In ordinary breathing, a 
man on an average breathes 25 cubic inches of 
air at each breath, but he can inspire or expire 
another 100 cubic inches by a forcible effort, and 
even after complete expiration there is 100 cubic 
inches of air left in the lungs, so that the total 
amount after the deepest possible breath is 325 
cubic inches. The air breathed out contains 
about forty volumes of carbonic acid in a thous- 
and parts, while pure air only contains from a 



Lungs and Air Passages. 323 

fifth to half one volume. When the air of a room 
contains one and a half to three volumes it causes 
headache and giddiness, while if it increases to 
twenty volumes it causes stupor and suffocation. 

In ordinary health, the number of respirations 
in a minute is from fifteen to twenty, or one 
breath to every four beats of the pulse ; but it is 
largely increased by exercise and various dis- 
eases, in which it often forms an important sign 
both as to its frequency and fullness. During 
sleep and in a few diseases the frequency is 
diminished; if much diminished it is generally 
an unfavorable sign. Expiration is longer than 
inspiration. 

To detect changes in the lungs indicating dis- 
ease, as we can neither see nor touch them, we 
must be content with hearing, and to a less extent 
the resistance to shock. The principles by which 
we judge of the state of the lung are purely 
mechanical and depend on the facts that — 

1st. Air in passing through tubes gives a 
shriller or more treble sound the smaller and 
shorter the tube. 

2d. Large bubbles produced by air passing 
through a tube give a graver or more bass sound 
when they burst than small bubbles. 

3d. Dense solids give a duller sound when 
struck, and conduct sound better, than porous 
bodies, and an empty closed cavity gives a still 
lighter and more resonant sound, of which an 



324 Dr. J. Kean's Lectures. 

empty cask, a cask filled with cotton wool, 
and a cask filled with water may be taken as ex- 
amples. A corked empty tin flask floating in a 
cask filled with water would give percussion 
sounds comparable to those given by a cavity in 
the lung. For listening to the sounds produced 
in the chest, or auscultation, medical men use an 
instrument called a stethoscope, the advantage of 
which, beyond its convenience, is that it localizes 
the sound and so prevents confusion of two 
sounds. For ascertaining differences in density 
of the lungs or level of fluid in the chest a finger 
is laid on the part and smartly tapped with the 
pulp of another finger, which is called percussion. 
That we may be able to judge of the changes 
in the chest, we must first hear the sounds, and 
then interpret them ; this cannot be done at the 
first trial any more than learning to play the 
piano, a skillful stethoscopist being as rare as a 
good pianist; while for delicate percussion both a 
nice sense of touch and a musical educated ear 
are necessary. Excepting for very loud sounds, 
such as are heard in bronchitis and asthma, it 
requires training and practical experience to hear 
them, and still more to judge of their causes and 
probable consequences. 

HAY ASTHMA 

Is a peculiar form of asthma, and also fever 
called Hay Fever, which affects certain persons 



Hay Asthma. 325 

during the months while haymaking is going on. 
It is caused by breathing the pollen of the sweet- 
scented vernal grass (anthoxanthum odoratum). 
Breathing ipecacuanha powder has the same 
effect on others, and in some even tine dust not 
known to contain anything specific has the same 
effect, acting perhaps by its mechanical action. 
The symptoms are sneezing, watering of the eyes 
and running at the nose, severe headache, chiefly 
in the forehead, cough, difficulty of breathing 
occurring in paroxysms and accompanied by a 
wheezing sound. 

The liability to it is often hereditary, but 
though troublesome it is never a dangerous af- 
fection. It is not brought on by cold or other 
causes of catarrh. 

Treatment. — Avoid going near hay fields, or 
if this cannot be done, wear a cotton wool respir- 
ator, covering both mouth and nose. Sponge the 
chest daily with cold water. 

Take 

Quinine 2 grains. 

Phosphate of iron 3 grains. 

Mix. 

Make three powders. 

Dose — One, thrice daily. 

During an attack breathe very dilute chlorine 
gas if it can be had ; if not, half a drachm of 
ethereal tincture of lobelia, repeated in an hour 
if necessary. 



326 Dr. J. Kearts Lectures. 

BRONCHITIS 
Is an inflammation and swelling of the lining 
membrane of the air tubes or bronchi; the 
natural mucous membrane is at first arrested 
and then becomes increased and altered in qual- 
ity. It is perhaps the most common of all dis- 
eases, nearly every one having occasionally had 
a " cold on the chest," and next to consumption 
in this country, it is the most fatal, especially to 
the aged and infants. No disease varies more in 
its degrees of severity than bronchitis from slight 
and easily cured colds to the most dangerous and 
unmanageable forms. Certain conditions predis- 
pose to bronchitis, and in such an attack is 
excited by what would have no effect on most 
persons. Those conditions are : childhood, badly 
fed people of weak fibre; a constitutional ten- 
dency to it as in the scrofulous — such persons 
are said to have a delicate chest; previous 
attacks. The direct or exciting cause in by far 
the most cases is chilling of the skin, espe- 
cially when heated; such as sitting in a 
draught, when perspiring, or damp feet, which 
causes bronchitis by reflex action : Other causes 
are, direct irritants to the mucous membrane, 
such as dust, common with millers and stone- 
cutters ; irritant gases or vapors ; very cold or hot 
air; obstruction to the blood, such as by heart 
disease or continued flatulence, leading to con- 
gestion and bronchitis; blood poisons, such as 



Acute Bronchitis. 327 

measles, typhoid fever, and small pox ; extension 
of a cold in the head down the windpipe. 

The danger is in proportion to the smallness 
of the air-tubes involved, the small ones being 
choked up by the swollen membranes and secre- 
tions, while the large tubes are almost as wide 
as before. Inflammation of the small tubes (cap- 
illary bronchitis) occurs mostly in children and 
old people, the vigor of adult life resisting the 
extension of the disease. It may produce two 
directly opposite results : in some the small tubes 
are choked, the air in the cells absorbed, and the 
walls come together, or the viscid mucus may 
act like a valve, allowing the air to pass in but 
not out, producing emphysema. 

Acute Bronchitis of the larger tubes (common cold 
on the chest.) — The symptoms described with cold 
in the head, pains all over, aching in the back, 
limbs, and joints, tightness across the forehead, 
chills, discharge from the nostrils, copious flow of 
tears, hoarse or rough voice, dry throat, furred 
tongue,' thirst, loss of appetite, quick pulse, and 
fever may precede the attack, but it generally 
begins with a sense of uneasiness, seldom 
amounting to pain, at the root of the windpipe 
behind the top of the breast-bone, which soon 
passes down the whole length of the bone, 
giving rise to a feeling of rawness with tight- 
ness and oppression of breathing, but no stitch 
even on taking a full breath, and accompanied 



328 Dr. J. Kean's Lectures. 

by frequent yawning. The voice is hoarse and 
altered. 

After a short time a dry cough commences 
and increases the irritation. The patient feels as 
if there was some foreign body in the chest, and 
makes violent and ineffectual efforts to cough it 
up. After twelve to twenty-four hours he begins 
to spit small quantities of a thin, frothy fluid, and 
soon after small irregular masses. In the subse- 
quent twenty-four to thirty-six hours the cough is 
easier, and can to a certain extent be repressed ; 
when it does occur there is no longer the great 
uneasiness and feeling of tearing formerly pro- 
duced. With each cough opaque yellowish spit 
no longer frothy is brought up with ease and a 
sense of great relief. The quantity in twenty-four 
hours varies. The breathing is hurried and the 
pulse is small and quick. 

Acute Bronchitis of the smaller tubes (capillary 
bronchitis) — Is one of the dangers of children 
from whooping cough. The attack may begin 
with chills, headache, furred tongue, pale face, 
an anxious expression and incessant hacking 
cough, with general weakness as in the first stage 
of fever. The pain is chiefly at the insertions of 
the muscles on the chest, and is due to the con- 
tinuous violent jerking of the cough. The breath- 
ing becomes hurried and laborious, and along 
with the cough there is an occasional expector- 
ation of one or more greyish-yellow pellets, 



Chronic Bronchitis. 329 

which if deposited into water show thread-like 
branches hanging down, which is the secre- 
tion of the small tubes hanging to the lighter 
frothy secretion of the larger tubes. These 
symptoms continue to increase, the breathing 
becoming quicker and more difficult, and the 
breathlessness increasing. The respiration may 
amount to seventy in a minute, and the pulse to 
120 or 130 After a time, as mucus accumulates 
and chokes more tubes, the lips, ringers and toes 
become livid or lead-colored from deficient oxida- 
tion of the biood, drowsiness and stupor com- 
mence and gradually go on increasing to the 
fatal termination. One reason why it is so fatal 
to children is the great difficulty they have in 
coughing up the phlegm. 

Chronic Bronchitis is very common in advanced 
life. It may remain from an acute attack, or 
begin as a chronic form. The most characteristic 
symptom is the cough, which is habitually full 
and easy, not like the dry difficult cough of begin- 
ning acute bronchitis, though there may be an 
acute aggravation of the disease, making the 
cough difficult and painful. The cough is more 
frequent in the morning after waking, and in 
the evening than during the day and the expect- 
oration is usually abundant, consisting of opaque 
masses of a dirty white, greyish, or greenish color 
occasionally with an offensive odor. Winter 
cough, occurring at first during spring or autumn, 



330 Dr. J. KearCs Lectures. 

till finally it remains more or less all the year 
round, is of this description. 

Plastic Bronchitis, with casts of the tubes, is a 
chronic form of bronchitis in which a false mem- 
brane is thrown out on the surface of the small 
tubes and air cells. It generally occurs between 
twenty and fifty years of age in persons of a deli- 
cate constitution, scrofulous, or with a tendency 
to gout or rheumatism. The expectoration when . 
thrown into water gradually expands into a stem 
and branches like a tree, the main stem being 
from the thickness of a crow quill to a pencil, 
and either solid, of a dull white color, or hollow, 
of a brownish color, from admixture with blood. 
They are gradually formed by exudation in the 
air tubes, and cause slight symptoms of bron- 
chitis till coughed up, when immediate relief 
follows, lasting till a new accumulation forms. 
It is not very common and is not immediately 
serious. 

Treatment. — At the beginning of a common 
cold in an adult, with hoarseness and tendency 
to cough, if the appetite is still good, it may be 
subdued by a full supper and what used to be 
called a night-cap, that is a tumbler of hot spirits. 
If tolerably severe but not of long duration, take 
of opium 1 grain, and of carbonate of ammonia 2 
grains at bedtime and confinement to the house 
the following day generally suffices; the effect 
being to arrest the perverted nervous action, 



Bronchitis — Treatment. 331 

which by reflex action from the skin is the cause 
of the cold. If such remedies are too long de- 
layed the next object to be aimed at is to excite 
copious perspiration, with action of the kidneys, 
and restore the moist state of the bronchial 
mucous membrane. The membrane being now 
inflamed, stopping the perverted nervous action 
is not sufficient ; we must endeavor to soften the 
expectoration and make coughing loose and easy. 
This is best done by small doses of expectorants, 
such as ipecacuanha wine 10 drops every two 
hours. Inhaling steam, say three minutes every 
two hours, with acetate of potash 10 grains three 
times a day. When the affection has lasted some 
time the potash may be replaced by syrup of 
squills half a drachm, and tincture of hyoscy- 
amus 15 drops four times a day. 

In acute bronchitis the chest must be covered 
with hot poultices and an oil silk jacket worn 
over it to prevent the steam and heat escaping. 
A single dose of cream of tartar, half an ounce to 
be taken in warm gruel, and ipecacuanha wine 
10 drops every two hours till the cough is loose. 
A mustard poultice once a day until the skin be- 
comes reddened, after the fever has subsided, if 
cough and difficulty of expectoration remain. 
Carbonate of ammonia 2J£ grains every three 
hours for an adult. The food should be fluid, 
milk warm from the cow if possible, beef-tea, 
gruel, tea, etc. The patient should be confined 



332 Dr. J. Kean's Lectures. 

to bed, and the air of the room kept moist, 
between 65° and 70°. 

The bowels should be kept gently open when 
required by sulphate of magnesia, and the follow- 
ing should be given thrice a day: carbonate of 
ammonia, 23^ grains, and compound tincture of 
camphor 15 drops. Steam should be inhaled 
twice a day, and a teaspoonful of turpentine 
placed in the hot water once every second day. 
Nourishing food ; wine when there is much weak- 
ness ; and a respirator, to be worn when exposed 
to cold air, are the other measures to be taken. 
Occasional Turkish baths in slight cases are 
useful. 

BKONCHIECTASIS 
(Dilated Am Tubes) 
May arise of itself or secondary to many diseases 
of the lungs. The disease is not uncommon, and 
may terminate in consumption. When a lung 
diminishes, either bodily or partly, as from pneu- 
monia or abscess, the ribs do not yield to fill up 
the space, hence there is a partial vacuum, and 
the pressure of the air on the bronchi slowly 
dilates them. The disease appears slowly, with 
symptoms of bronchitis ; there is frequent cough 
occurring in paroxysms, and which is soft, moist, 
painless, bringing up with difficulty large quanti- 
ties of expectoration of an offensive odor. There 
is impaired general health, breathlessness on 



Asthma. 333 

exertion, and offensive breath from the secretions 
lying in the enlarged tubes putrefying. The 
expectoration is in large quantity of round foetid 
masses and brought up occasionally after cough- 
ing; from the putrefaction of the secretions, 
there is sometimes death from pyyemia. 

Treatment. — Alcoholic liquors. 

Dose — One teaspoonful every half hour, in milk. 

Take 

Tincture of aconite 20 drops. 

Fluid extract of veratrum .20 drops. 

Water 4 oz. 

Mix. 

Dose — One teaspoonful every two hours, in 
water. 

Alternate with the following (see precaution- 
ary rules, Lecture XVII): Compound tinc- 
ture of camphor, 10 drops every two hours ; 2 
grains of tar three times a day ; a mustard poul- 
tice over the chest eveiy second day, to redden 
the skin ; with beef tea and milk diet. 

ASTHMA 
Is a complex and capricious disease, occurring 
in paroxysms of difficult breathing of variable 
duration, and is caused by spasmodic contraction 
of the circular muscular fibres of the smaller 
bronchi. It occurs at all ages, though more 
common in adults, and not un frequently it is 
hereditary. Except when connected with cer- 
tain organic changes in the heart and lungs, the 
sufferer may enjoy tolerably good health between 



334 Dr. J . Kean's Lectures. 

the attacks, the intervals between which vary 
from a few minutes, in severe cases, for a succes- 
sion of several attacks, when it may subside, to 
a year or even more in very slight cases. The 
direct exciting causes of the disease are various. 
It may be due to exhaustion and fatigue ; to sud- 
den violent mental emotions ; to irritation of the 
stomach from indigestible food ; skin eruptions, 
or irritation from loaded bowels. 

A fit of asthma is preceded either by headache 
and sleepiness or various digestive disturb- 
ances, or it may occur suddenly without warn- 
ing. The attack generally occurs at night, and 
if the sufferer should be asleep it gives rise to 
uneasy slumber and frightful dreams ; when he 
awakes he has a great desire to draw a deep 
breath, but feels that the air does not penetrate 
into the chest beyond a certain point. There is 
a sense of suffocation or constriction about the 
chest, with increasing difficulty of breathing, till 
it becomes a painful struggle for breath. The 
chest is expanded to the utmost, the arms braced, 
and the head thrown back to favor breathing, 
but in vain. Loud wheezing and shrill whist- 
ling, or hissing, of every variety of note and 
pitch, which may be heard a considerable dis- 
tance, accompany the breathing, loudest on ex- 
piration, and disappearing from one part of the 
lungs to appear in another, showing that the 
spasm of the muscular fibres has relaxed in one 



Asthma'. 335 

spot to appear in another. The countenance is 
anxious, the eyes widely opened and staring, the 
face pale, the lips purple, the forehead covered 
with cold perspiration, the pulse small and weak. 
The attack, after lasting a quarter of an hour to 
several hours, often terminates by expectoration 
of mucus, which may be light and frothy, thick 
and heavy, or in severe forms, dark pellets. The 
attack may end suddenly, the air rushing into the 
cells, or gradually accompanied by loud belch- 
ings of air, yawning, or rarely a fit of coughing ; 
after which relief returns, and the sufferer falls 
asleep. Most asthmatics are thin [see Fig. 40], 
round-shouldered, hollow cheeked, and have a 
hoarse voice and slight cough. 

Treatment. — Asthma is capricious in its cure. 
During the attacks, if the stomach contains 
an undigested meal, an emetic should be given, 
followed, after retching has subsided, by a mus- 
tard poultice applied to the chest, and a small 
cup of very strong coffee, or a glass of spirits 
taken. If the attack still continues, three drops 
of chloroform may be tried every quarter of an 
hour. Inhaling the fumes of burning nitre paper, 
smoking stramonium seeds or — 
Take 

Powdered lobelia 1 oz. 

Powdered skunk cabbage 1 oz. 

Powdered stramonium leaves 1 oz. 

Nitrate of potash 1 oz. 

Mix. 



336 



Dr. J. Keari's Lectures. 



And burn two tablespoon Ms on a dish in the 
bed room, previous to, or during an attack. 
During the intervals the patient must avoid all 




Fig. 40.— Asthma. 
causes, no matter how seemingly trivial, which 
in his experience have led to attacks. A cold 
shower or sponge bath daily, and 3 grains extract 



Emphysema. 337 

of conium, with solid extract of belladonna % 
grain, to be taken thrice daily in severe cases. 

EMPHYSEMA 

Is a disease of the lungs which occurs in two 
forms: one vesicular, in which the air cells or 
vesicles are largely expanded, the walls waste and 
several cells are thrown into one ; the other, inter- 
stitial emphysema, occurs suddenly after a violent 
effort, when some of the air cells rupture and the 
air gets in between the cells. When the affection 
is of small amount it causes no particular incon- 
veniences, and is not inconsistent with attaining 
a good old age, but if considerable the patient 
is short-winded and distressed by a constant sense 
of fullness and oppression at the chest, often with 
attacks of- asthma. The breathlessness is increased 
by exertion, with weak voice, feeble cough, dusky 
face, stooping gait, weak slow pulse and lowered 
temperature of the body ; if the disease increases 
there is loss of flesh and strength, leading to gen- 
eral dropsy from the obstacles to the passage of 
blood through the lungs, and consequent increase 
of blood pressure in the veins, causing transudation 
of the watery part of the blood ; the chest becom- 
ing round and barrel-shaped, and a full expiration 
cannot be made, the chest being still prominent 
after all the breath that can be expelled is breathed 
out. A small amount may be due to collapse of 
a part of the lung, when the balance has to 

22 



338 Dr. J. Kearts Lectures. 

expand to fill the vacant space, the walls of the 
chest preventing its falling in. Larger amounts 
are usually due to violent expiration, such as pro- 
longed playing on wind instruments, or whoop- 
ing cough, the midriff pressing up the air in the 
lower part of the lung, and not being allowed to 
escape, the pressure gradually enlarges the air 
ceils at the top of the lung. Bronchitis is another 
cause, the secretion in the small tubes sometimes 
allowing air to pass in but not out again. 

Treatment must be directed to prevent further 
extension of the disease, the distended cells being 
incapable of returning to their former size, several 
cells having run into one. Good food, warm 
clothing, rest, and a warm climate if possible ; 
and the treatment of asthma for paroxysms of 
breathlessness. 

HAEMOPTYSIS 
(Bleeding from the Lungs) 
Is not of serious consequence when it is of small 
amount, not repeated and due to some passing 
cause, but when frequently repeated, or of large 
amount, it is very apt to be followed by consump- 
tion, some of the blood flowing back into the air 
cells and setting up chronic pneumonia ending 
in consumption. Consumption may be either a 
cause or an effect of the bleeding. It may be a 
cause by a cavity eating into a blood vessel, and 
causing a profuse, perhaps fatal, hemorrhage ; or 
by rendering the wall of the minute arteries per- 



Pneumonia. 339 

vious to the blood ; and as already mentioned, it 
may be an effect from bleeding even in a strong 
and vigorous person. In most cases of even sudden 
and profuse hemorrhage there is no blood vessel 
opened the blood coming from the membrane of the 
lungs in the same way that it does from the nose 
in spontaneous bleeding, or from the congestion 
caused by fevers. Hemorrhage from the lungs 
is not often fatal at the first attack, and patients 
may survive an enormous loss of blood. 

Treatment. — Strict rest, lying in bed with the 
head and shoulders raised on pillows. Ice ap- 
plied to the chest. 

Take 

Hamamelis Virginica bark 1 oz. 

Boiling water 1 pint. 

Mix. 

Dose — A wineglassful every few hours. — Or the 
following are good: Ligate (tie with any stout 
cord round) the limbs close to the body; lead is 
used with good effect. My reasons for avoiding 
[see Poisons, Lecture XVII]. Any of the follow- 
ing are at times very valuable: Gallic acid, 
ergot, turpentine, common salt. 

PNEUMONIA 
(Inflammation of the Lungs) 
Presents several well-marked forms. 

Exudative Pneumonia — Where an exudation is 
thrown out into the air-cells, forming a solid 
mass of condensed lung tissue. 



340 Br. J. Kean's Lectures. 

Interstitial, or Cirrhosis. — Where the fibrous 
tissue between the cells is increased, and shrinks ; 
this is chronic, and will be considered under 
Consumption. 

Of the first form (Exudative Pneumonia) the 
varieties are : 

Lobar. — Where a whole single lobe of a lung 
is affected, about twice as often in the right lung 
as in the left, and usually in the lower lobe, in 
more severe cases the upper lobe. The lobe is 
congested, the vessels gorged with blood. 

The air-cells become filled with red corpus- 
cles (red hepatization). 

The red exudation becoming grey. 

It softens into pus, the lung being like a 
sponge filled with pus. This form of inflamma- 
tion is most common in adults, and may termi- 
nate by restoration to health, abscess of the lung, 
gangrene or consumption. 

Lobular or Catarrhal Pneumonia affects groups 
of cells or lobules, scattered all over the lungs. 

Bronchial Pneumonia is always preceded by 
bronchitis, the inflammation spreading from the 
bronchi to the air-cells and lung tissue. Acute 
bronchial pneumonia is the ordinary form in 
children, biit rare in adults ; along with capil- 
lary bronchitis it is a very frequent source of 
death in children. Chronic bronchial pneumo- 
nia is a consumptive or scrofulous form of pneu- 
monia (see Consumption). This pneumonia is 



Pneumonia. 341 

always preceded by catarrhal bronchitis, which 
extends into the air-cells of the lungs, and sets up 
numbers of small pneumonias each affecting one 
lobule. 

Metastatic Pneumonia is produced by pus or 
clots getting into the circulation and sticking in 
the minute blood-vessels of the lungs, where, if the 
pus is infective, it sets up an abscess. 

Symptoms and treatment of all the acute forms 
of pneumonia are the same. The disease gene- 
rally begins with a strong chill, and feeling of 
cold, though the temperature is really increased. 
In children the shivering fit is often replaced by 
convulsions, the temperature rapidly rises to 
103° F., the face is red and flushed, .there is 
pain in the side, but not of the sharp, lancina- 
ting character of that in pleurisy, unless it is also 
present, and it is felt at the point where the in- 
flamed lung touches the wall of the chest. It is 
made much worse by a deep breath, coughing, 
sneezing or pressure on the chest. The pain 
gradually abates or ceases, and in old or very 
weakly persons may be absent from the begin- 
ning. There is thirst, white tongue, constipated 
bowels, hot, dry skin, no appetite and thick 
scanty urine. The patient generally lies on his 
back, and has a frequent, short harsh cough, 
which he strongly endeavors to repress on ac- 
count of the pain it causes. There is a tenacious 
saliva, which is apt to stick to the mouth. The 



342 Dr. J. Kecm } s Lectures. 

breathing is very rapid, forty or more short breaths 
being drawn in a minute, from which speech is 
interrupted; even a short sentence cannot be 
finished without a fresh inspiration of breath. 
There may be delirium towards the evening. In 
very severe attacks, pointing to a fatal termina- 
tion, the face becomes dusky, the tongue brown, 




Fig. 41.— Pneumonia. 

perspiration flows over the body, and delirium 
of a low, muttering type, ending in stupor [see 
Fig. 41]. 

In the aged and weakly, cough, pain, breath- 
lessness, and the characteristic saliva may be 
wanting, the only signs in the absence of a 
stethoscopic examination being extreme weak- 



Pneumonia. 343 

ness, quick breathing, and fever. The symptoms 
of the disease continue constant, or increase till 
about the end of the first week, when a striking 
change often takes place in the course of a few 
hours. The temperature and pulse fall, the 
breathlessness abates, and the patient feels freer 
and easier, and in the course of twenty-four hours 
conralescence is often fully established, the patient 
sleeps and calls for food. The total duration of 
the disease in uncomplicated cases is about four- 
teen days. In some cases there is merely a short 
remission, the disease growing worse again, the 
patient becoming very weak and delirious, or 
lying in a state of stupor ; but a change for the 
better may still take place about the end of the 
second week. 

Death may take place from blood-poisoning, 
the inflamed lung not being able to aerate the 
blood coursing to it, and the extra pressure on 
the remainder leading to the effusion of fluid into 
the air cells (oederna), a kind of internal dropsy. 
When this takes place the uneasiness becomes 
greater, the breathing louder, the face more livid 
and swollen, the cough more harassing, expector- 
ation more abundant, and the attempt to lie 
down becomes impossible. In others death may 
take place from exhaustion. 

Like all other inflammations, one attack leaves 
the part weakened and more liable to subsequent 
attacks. 



344 Dr. J, Kean\$ Lectures. 

Treatment. — Perfect rest in bed, the air of 
the room being kept moist by steam and at a 
temperature of 70° F. The medicines required 
are different in almost every case, no general rule 
can be given for selection. Carbonate of am- 
monia 2 grains, if there is weakness, is perhaps 
the most generally useful remedy. If there is 
much weakness, four tablespoonfuls of whiskey 
every three hours, along with beef-tea and milk. 
Small doses of opium, 1 grain every six hours 
when the pain is severe. A large linseed poul- 
tice over the seat of pain. Iodide of potassium 
3 grains, combined with compound syrup ot 
stillingia, thrice a day in chronic cases, along 
with nourishing diet; or quinine and iron are 
used in different cases with good effect. 

PHTHISIS. 

(Consumption.) 
Consumption is the most fatal of all diseases 
in this country. By consumption is understood 
a condition of lung ready to break up and 
form cavities, and until recently it was supposed 
to be always due to the formation of a growth 
called tubercle, which is the result of a peculiar 
state of constitution — the scrofulous constitution. 
You may, and often do, have scrofula without 
tubercle ; but you never find true tubercle without 
scrofula. In infancy it is most apt to be found in 
the head, causing acute hydrocephalus. In 



Acute Consumption. 345 

childhood, in the glands of the bowels, causing 
consumption of the bowels (tabes mesenterica) ; 
and in adolescence, it attacks the lungs. It is 
now known that consumption may be due to 

Tubercle and 

Chronic pneumonia of various kinds. 

Tubercle is a growth of numerous small semi- 
transparent grey bodies about the size of a pin's 
head, which grow under the mucous membrane 
of the small air tubes and air cells. When sev- 
eral touch each other they excite a small pneu- 
monia or inflammation, the exudation of which 
mats them together, and they undergo fatty 
degeneration, forming yellow tubercle, a cheesy- 
looking mass the size of a bean, which is usually 
surrounded by a ring of fresh young grey 
tubercles. The yellow tubercle then usually 
softens and breaks down, leaving a cavity. In 
acute spreading consumption the walls of the 
cavities are of soft, cheesy, breaking-down tissue ; 
if the process is arrested, the cavity becomes 
lined with a mucous membrane, shrinks, and 
may heal entirely, leaving a scar in the lung. 

ACUTE CONSUMPTION 

Is comparatively rare. The purely tuberculous 
form causes death before there is any destruction 
of lung tissue, the lungs being uniformly speckled 
with grey. Death usually takes place within 
five weeks, with symptoms not unlike typhoid 



346 Dr. J. Kean's Lectures. 

fever, for which it is sometimes mistaken. In 
one remarkable case I have seen in Colorado, 
which occurred in a young woman twenty years 
of age, there were no signs of any kind for the 
first ten days, beyond a scrofulous constitution 
and persistent high temperature; she was una- 
ware of anything being wrong with her lungs, 
having sought advice for quite a different ailment. 
Great weakness, hurried breathing, slight cough, 
profuse perspiration, and finally delirium ap- 
peared, the patient dying in the fifth week after 
high temperature set in. 

ACUTE PNEUMONIC PHTHISIS 
(Galloping Consumption) 
Is a somewhat more common form, though still 
rare compared with the chronic forms. It usually 
commences suddenly with chills, fever, rapid 
pulse, pain, cough, breathlessness, closely fol- 
lowed by hectic fever, a form of fever occurring 
in wasting diseases with remissions and aggra- 
vations. The face is pale or waxy-looking, with 
rosy spots or flushes, especially over the cheek 
bones ; the pupils of the eyes are usually dilated, 
the fever increases, and the skin assumes a heated 
condition toward evening, and diminishes again 
with the approach of morning, when the patient 
falls asleep and awakes saturated with perspira- 
tion of a more or less sourish odor, and which is 
termed colliquative, because it seems to melt the 



Chronic Consumption. 347 

patient away. Along with the hectic fever there 
is rapid loss of flesh and strength, and often 
diarrhoea ; cavities form in the lungs, and death 
takes place from exhaustion in three to ten weeks 
after the commencement of the disease. It arises 
from extension into the air cells of bronchitis, 
setting up lobular pneumonia, or small inflam- 
mations of separate lobules, which does not heal 
but softens and breaks down into cavities, and 
bears the same relation to chronic consumptive 
pneumonia that an acute inflammation has to a 
white swelling or scrofulous external inflamma- 
tion. 

CHRONIC CONSUMPTION 

Has much the same symptoms from whatever 
cause it arises. 

Pure tuberculous consumption — that is, in which 
there are no symptoms till tubercles form, excite 
local inflammation, degenerate and break down 
— is the rarest form of ordinary consumption. 
There is no premonitory bronchitis, cough, or ex- 
pectoration. Fever and wasting, with loss of 
strength, shortness of breath, and pale features, 
precede the cough and changes in the chest, 
usually by several weeks. The voice and cough 
become hoarse, and exhaustion is hastened by 
profuse diarrhoea from tubercle becoming depos- 
ited in the bowels, the patient generally dying in 
a few months. 



348 Dr. J. Keaii's Lectures. 

Tuberculo-pneumonic consumption, on the other 
hand, is much the most common form of this de- 
ceitful and deadly disease. In this form bron- 
chitis extends to the small air-vessels and air- 
cells, setting up lobular pneumonia, the exuda- 
tion of which is soon surrounded by crops of tu- 
bercle, and the mass degenerates, softens, and 
breaks down, forming cavities. One lung only 
may be affected, in which case it is generally the 
left, but more commonly both lungs are affected, 
beginning at the apex, and the left lung being 
more extensively affected than the right ; cough 
and expectoration preceding the signs of con- 
sumption proper by a variable time, usually from 
two to three weeks. 

Chronic pneumonic phthisis may be due to old 
hardened portions of lung from preceding pneu- 
monia slowly breaking down and forming cavi- 
ties, or more commonly from chronic lobular 
pneumonia, the exudation of which breaks down 
into cavities. 

Any form of pneumonia may leave a hardened 
portion of lung which, after a time, under pecu- 
liar circumstances, softens and breaks down, 
forming a cavity instead of immediately being 
liquefied and becoming absorbed. This usually 
occurs from a long-continued bronchitis setting 
up chronic inflammation or pneumonia of the 
separate small lobules, which in feeble constitu- 
tions culminates in consumption. 



Chronic Consumption. 349 

Cirrhotic or fibroid consumption is a form of 
diffused chronic pneumonia, in which the fibrous 
tissue only, or chiefly, of the lung substance be- 
comes chronically inflamed and afterwards slowly 
shrinks, occupying less space, by which the chest 
contracts and the bronchi dilate into round ob- 
long spaces, the lung tissue becoming com- 
pressed and impenetrable to air. 

This kind of consumption is common among 
coal-miners, stone-masons, etc., the constant inha- 
lation of the particles causing irritation and set- 
ting up a slow inflammation of the fibrous tissue. 
It may also be produced by a prolonged course 
of spirit-drinking, the ordinary drunkard's con- 
sumption, and also from fibrous tissue replacing 
the absorbed material of pneumonia, the fibrous 
tissue afterwards shrinking as we see in the scars 
of external wounds. This form of consumption 
is commonly a considerable time in running its 
course, often extending over several years. 

Symptoms. — In the great majority of cases, the 
earliest symptom is a cough, at first slight, dry, un- 
accompanied by expectoration, and occurring at 
particular times : upon rising from bed in the 
morning (always a warning symptom), on mak- 
ing any violent exertion during the day, and 
again at night. The cough may cease almost en- 
tirely during warm weather, to return again when 
it becomes cold, and continue gradually increas- 
ing. Cough without any apparent cause is 



350 Dr. J. KearCs Lectures. 

always to be regarded as an alarming and suspi- 
cious circumstance. If the commencement of ex- 
pectoration shows sharply-defined deep-yellow 
streaks, it is a bad sign, showing that the small 
bronchi and air-cells are involved. 

The breathing becomes more frequent than in 
health. Flying pains about the collar-bones 
occur, of a dull, aching character, but are not 
unfrequently absent. Very often there is haem- 
orrhage from the lungs, varying from a few 
streaks of blood in the expectoration, to copious 
bleeding, which may occur at any stage of the 
disease, and is of frequent recurrence. Hectic 
fever approaches insidiously, with pale face and 
a pink flush over the cheek bones. The appetite 
becomes impaired, with a dislike for fatty food. 
The pulse becomes quick and weak, perspirations 
occur chiefly during sleep, and are often very 
profuse. The expectoration is in rounded globu- 
lar masses, but this may also occur in some 
forms of bronchitis. The expectoration often 
contains elastic fibres of lung substances, visible 
under the microscope, from the walls of the air 
cells, which is a sure sign of consumption, and 
sometimes hard grains of degenerated lung. 
Wasting originates early, and bodily strength 
and flesh rapidly pass away. The fever is gen- 
erally about two degrees higher in the evening 
than the morning. There may be no increase of 
temperature in the morning, and a temperature 



Chronic Consumption. 351 

of 102° F. or more by five o'clock in the after- 
noon. Diarrhoea frequently sets in towards the 
close, and the consequent exhaustion terminates 
the scene, or a profuse flow of blood from the 
lungs may be the immediate cause of death. 
Sometimes a fistula in the bowel is one of the 
earliest eflects of consumption. The duration of 
consumption varies from a few weeks to twenty 
or more years, more than half dying within six 
months from the first appearance of the complaint. 
Though no period of life is exempt from this 
scourge, yet it is most common between the ages 
of eighteen and twenty-five. 

When a patient with only chronic bronchitis, 
the general health and activity still unaffected, 
begins to lose appetite, to find a marked decline 
in his strength and to become pale and emaci- 
ated, it shows the disease has extended to the air 
cells, and requires instant attention lest it should 
culminate in consumption. The chance of re- 
covery is better in one having a hereditary ten- 
dency to consumption, than in a person of strong 
constitution in whom it has been acquired, if 
they have both the same extent and stage of disease. 
Consumption was long regarded as incurable, but 
now it is admitted as a curable disease, though 
not easily cured. Though patients may occa- 
sionally be able to ascribe the first occurrence 
of symptoms to a definite cause, yet far more fre- 
quently the exciting cause, such as exposure to 



352 Dr. J. Kean's Lectures. 

cold, as well as the first symptoms, are alike 
obscure. A slight cough, more annoying by its 
continuance than its severity, and often called by 
the patients themselves an irritating cough, lan- 
guor, slight wasting, easily induced fatigue, and a 
tendency to night-perspirations, are among the 
earliest symptoms which draw attention. That 
feeble, ill-nourished people should be in far 
greater danger of becoming consumptive than 
strong, vigorous, well-nourished persons is what 
we should expect. In such feeble, ill-nourished 
persons every cell and tissue is also weak and less 
capable of resisting disease, the whole being made 
up of its parts ; but the weakest part, and hence 
the part most liable to disease, varies at different 
periods of life. During childhood they are more 
liable to croup, affections of the head, and moist 
eruptions of the skin ; after puberty to inflamma- 
tions and bleeding from the lungs. Such persons 
are said to be sickly, that is, are more liable to dis- 
ease, and do not recover so quickly from its attacks. 
Their flesh does not heal, a trifling wound being 
apt to be followed by severe irritation and copious 
suppuration of the wounded part, which is partly 
due to an increased irritability which accom- 
panies constitutional weakness, and partly to the 
fact that weak or ill-nourished organs, when 
inflamed, show a great tendency to a copious 
formation of cells of a weak and perishable 
nature. When this occurs on free surfaces, such 



Chronic Consumption. 353 

as external wounds, a copious flow of pus is the 
result. Pus may also be formed by irritants 
weakening the part, and by migration of white 
blood cells through the walls of the small vessels. 
When it occurs in a confined space, as in the sub- 
stance of the lang, the mutual pressure of the 
numerous cells destroys their vitality, and they 
undergo fatty degeneration, the mass breaking 
down and forming a cavity. In scrofulous per- 
sons very trifling irritants, or mild inflammation, 
suffice to excite the glands into an active forma- 
tion of new cells, which may not lead to inflam- 
mation and breaking down, but cease with the 
consequent enlargement of the glands, or it may 
end in inflammation from such slight causes 
that it appears to be engendered of itself spon- 
taneously, for example, scrofulous ophthalmia, 
skin eruptions, etc. If this feeble power of 
resisting noxious agents has not subsided by the 
time the lungs become more especially liable to 
disease, the same trifling causes which formerly 
gave rise to ophthalmia, eruptions, etc., may now 
give rise to consumption. 

There are certain physical appearances in 
those affected with consumption, and also in 
those having a constitutional tendency to it: 
these are a clubbed shape of the extremities of 
the fingers, with the nails curved downwards, 
called claw nails ; a dilated state of the pupils of 
the eyes, a reddish or purplish line along the 

23 



354 Dr. J. Kean's Lectures. 

junction of the teeth and the gums, and the 
growth of hair down the back in the region of 
the spine. 

The great predisposing cause of consumption 
is insufficient or improper food and air. 

Another cause, the action of which is more 
difficult to explain, is dampness of the soil, low- 
lying damp situations being productive of con- 
sumption. Long-continued inhalation of dust, 
acting as an irritant, produces its own special 
form of consumption, fibroid or cirrhosis. 

Treatment. — Delicate children of weak or 
consumptive parents should not be nursed by the 
mother, but a vigorous wet nurse should be pro- 
cured, or be fed with milk direct from the 
cow. If the milk is vomited, one spoonful of 
sodawater should be added to three of milk. 
Fresh cream, with its own bulk of finely grated 
cracker, and one teaspoonful of brandy to two 
tablespoonfuls of the mixture, can at times be 
retained when all other food is rejected. Children 
of consumptive parents should use a daily tepid 
sponging; they should never be kept long at sed. 
entary occupations, and should have plenty of 
gentle outdoor exercise, avoiding very cold and 
wet weather. Fat meat ought to be given mixed 
with bread or potato. When consumption has 
actually begun there is no one remedy of equal 
virtue with iodine, which seems to have a special 
medicinal value, and when given in time along 



Chronic Consumption 355 

with proper attention to ventilation, warmth, 
exercise, and general habits, it usually prevents a 
threatened attack, and cures the earlier stages; 
in some cases far advanced consumption can be 
stopped by its use. A mustard poultice applied 
to the chest till the skin is reddened, every second 
day. If the fever should still continue, 
Take 

Sulphate of quinine 25 grains. 

Tincture of digitalis % oz - 

Water 4 oz. 

Mix. 

Dose — One teaspoonful thrice a day. 
When the disease has become chronic, 
Take 

Quinine 25 grains. 

Dilute sulphuric acid % oz. 

Syrup of prunus virginiana 8 oz. 

Mix. 

Dose — Two teaspoon tuls three times a day, lake 
a tablespoonful of whiskey or brandy in 1 oz. of 
milk for drink every few hours. 

The complications of consumption are very 
numerous, and each must be treated separately 
(see Bleeding from the Lungs, Indigestion, 
Diarrhoea, etc.) and in accordance with the gen- 
eral rules for consumption. Night sweats are 
checked by tincture of iron, 20 drops in water 
thrice daily. Cough may be relieved by half a 
drachm of ammouiated tincture of opium every 
four hours. Diarrhoea, by starch injection with 
20 drops of laudanum. Expectoration, by inhaling 



356 Dr. J. Kean's Lectures. 

cool vapor containing turpentine, a teaspoonful 
to a cup of warm water. Irritable heart, by two 
drops of hydrocyanic acid in a spoonful of syrup 
of prunus virginiana. Finally, if the patient can 
be removed to an equable dry climate, or an arti- 
ficial temperature so made by a furnace, by 
which means the heat is equalized, and there is 
no sudden change of air, it should be done. 

PLEURISY. 

(Inflammation of the Lining Membrane of 
the Lungs.) 

Like most inflammations, it may be acute or 
chronic, and might arise directly as from cold, or 
be caused by the blood-poisoning of some fever, 
such as scarlet fever. The varieties of pleurisy are : 

1st. Dry pleurisy where there is no secretion 
from the inflamed membrane, and which gives 
rise to no symptoms unless there is extensive ad- 
hesion of the two surfaces of the membrane, when 
it may occasion slight breathlessness. 

2d. Pleurisy with scanty fibrino-serous effu- 
sion (common pleurisy), the exudation forming a 
soft false membrane on the surface of the pleurae, 
which adheres them together in various places. 

3d. Pleurisy with abundant exudation. 

4th. When the sac of the pleura becomes 
filled with pus (empyema), which is thin and 
contains curdy flakes in chronic cases. 

Symptoms. — In pleurisy with scanty effusion, 



Pleurisy. 357 

the disease begins with chilliness or shivering, 
followed by fever and a sharp piercing pain or 
stitch in the side, usually a little below and to 
the outside of the nipple. The pain is increased 
by breathing, coughing, sneezing, and pressure 
on the affected part. There is generally a short, 
harsh, dry, frequent cough, which the patient re- 
presses as much as possible from the pain it 
causes. The patient bends to the affected side, 
and keeps his hand to it when coughing. The 
skin is hot and dry, the pulse quick and hard, the 
breathing short, cautious, and increased in fre- 
quency. A characteristic friction sound like the 
creaking of new leather may generally be heard 
at the seat of pain, and a rubbing sensation is 
sometimes felt by the patient, and may be felt by 
the hand laid over the place. 

There is no rusty-colored expectoration as in 
pneumonia, and the patient lies on the unaffected 
side. 

Pleurisy with abundant effusion. The incipient 
symptoms are generally more severe, like pneu- 
monia, severe shivering, high fever — 101° to 105° 
F., — headache, pains in the limbs, white tongue, 
stitch in the side, the pain of w T hich is worst at 
one spot, and together with the friction sound, 
disappears as the effusion is increased, breathless- 
ness and rapid breathing, the patient lying on 
the affected side to give the sound one full play. 
As the disease advances the pain abates or disap- 



358 Br. J. Kecvris Lectures. 

pears altogether. After six or eight days all the 
symptoms may undergo a marked decrease or 
cease altogether in a few hours, as in pneumonia, 
and the effused fluid begins to be rapidly 
absorbed. In other cases the fever abates 
at the end of the first week or a little la- 
ter, but this fluid is only partially absorbed, 
and after a time there is a relapse with re- 
turn of fever, cough, shortness of breath, and 
spitting of froth, and may drag on for months 
with alternate partial recovery and relapses, and 
often terminates fatally. 

It is sometimes difficult to distinguish pleurisy 
from pneumonia. The following are the points 
of difference: 

Pleurisy seldom begins with a single violent 
chill, while pneumonia usually does. 

There is not usually such a sudden change for 
the better in pleurisy as there is in pneumonia. 

In pneumonia there is a characteristic tena- 
cious rusty-colored spit ; in pleurisy it is frothy 
and may contain streaks of blood. 

Chronic Pleurisy may be left from an acute at- 
tack or may approach insidiously, and may escape 
the patient's notice till he finds his strength begin- 
ning to fail, with slight shortness of breath, he 
becomes pale and emaciated, with slight fever; 
the spaces between the ribs become lost from the 
bulging out of the muscles by the fluid, amount- 
ing to several pints ; such an effusion under the 



Pleurisy. 359 

most favorable circumstances is very slowly- 
absorbed, and is veiy apt to have relapses and 
finally to terminate in consumption, the lung 
becoming compressed and unable to expand 
when the pressure is removed. When pleurisy 
continues to the formation of pus (empyema), 
there is usually one or more strong shivering fits 
with an increase of the fever. The pus may 
open externally and cause a spontaneous cure, or 
into the lungs and be coughed up, usually unfavor- 
able. Water on the chest (hydrothorax) is com- 
monly part of a general dropsy and affects both 
lungs, pleurisy usually affecting only one lung. 

Air in the chest (pneumo-thorax) occurs gener- 
ally in consumption after some sudden exertion, 
such as coughing; the patient feels something 
tear, which is the rupturing of a small cavity, 
filling the sac of the pleura with air and giving 
rise to difficulty of breathing. 

Treatment. — Perfect rest in bed ; if the pain 
is severe, dry cupping. A large hot poultice 
over the side for an hour, followed by a fine flan- 
nel bandage round the ribs to prevent movement. 
5 grains Beach's diaphoretic powder every four 
hours while the pain continues, and then 

Take . 

Tincture of digitalis % oz. 

Quinine 25 grains. 

Acetate of ammonia 1 drachm. 

Water 4 oz. 

Mix. 



360 Dr. J. Keari's Lectures. 

Dose — One teaspoonful thrice a day, with a suc- 
cession of dry cupping to the affected side. In 
long-continued cases, iodide of potassium 3 grains 
thrice daily. When the fluid accumulates so as 
to threaten suffocation, secure the services of a 
physician of reputed skill, who is a graduate of 
a recognized college of medicine and surgery; 
he will tap by a hollow needle (trocar) plunged 
in between the seventh and eighth ribs, a little to 
the back of midway between the spine and breast- 
bone, and the needle sloping slightly upwards. 



LECTUKE X. 

DISEASES OF THE DIGESTIVE 
SYSTEM. 

Diseases op the Digestive Organs — Inflammation ot 
Mouth.— Toothache. — Inflammation and Ulcers of the 
Tongue. — Cracked Tongue and Ranula. — Quinsy. — 
Chronic Inflammation of Tonsils. — Inflammation of 
the Throat. Affections of the Stomach— Indigestion 
or Dyspepsia. —Inflammation of the Stomach.— Chronic 
Ulcer of the Stomach. —Vomiting of Blood from the 
Stomach. — Cancer of the Stomach. Affections of 
the Bowels — Inflammation of the Bowels. — Dysen- 
tery.— Bleeding from the Bowels. — Diarrhoea. — Colic. 
— Constipation. — Worms.— Piles. Affections of the 
Liver — Abscess. — Atrophy, and Cirrhosis. — Waxy 
Liver. — Fatty Liver. — Caucer and Tubercle. — Conges- 
tion of the Liver.— Jaundice. — Gall Stones. Affec- 
tions of the Peritoneum — Peritonitis. — Ascites, or 
Dropsy of the Abdomen.— Tabes Mesenterica, or con- 
sumption of the Bowels. 

STOMATITIS 
(Inflammation of the Mouth) 

IS a common disease in young children, and 
may occur in three forms, according as the 
mucous follicles of the mouth (a follicle is a 
little recess of mucous membrane constituting a 
gland), or bladders of fluid, the gums or the 
cheeks are attacked. Vesicular or follicular. 
There is difficulty in sucking, abundant flow of 
saliva, loss of appetite, restlessness and fever, the 



362 Dr. J. Kean's Lectures. 

glands under the chin are swollen and tender, 
and there is diarrhoea with offensive stools. 
Small vesicles form on the tongue and back of 
the throat, which burst and form ulcers covered 
with dirty-white sloughs. Ulcerative stomatitis 
(noma) begins by white spots on the gum of the 
lower jaw; there is heat of mouth, salivation, 
enlarged and tender glands under the chin, and 
the gums swollen and of a red or violet color, 
covered by greyish matter. If the disease con- 
tinues the gums are soon destroyed by ulceration, 
the teeth become exposed and loosened, and the 
inside of the cheek becomes involved. Gangre- 
nous stomatitis (cancrum oris). A hard red swell- 
ing arises on one cheek, which spreads and opens 
into a shallow ulcer on the inside, with a foetid 
discharge. As the disease advances the cheeks 
and lips begin to swell, the breath is foetid, the 
flow of saliva is increased, the gums become 
affected and the teeth fall out, the glands beneath 
the chin are enlarged and tender, and finally the 
patient may die exhausted. 

Treatment. — In the milder forms — 
Take 

Baptisia tinctoria, dilute and use with atom- 
izer ; gargle the mouth every hour with the fol- 
lowing to remove pain : 

Take 

Sulphate morphia . . .1 grain. 

Warm water 3 oz. 

Mix. 



Toothache. 363 

Give a gentle cathartic. Where the mouth has 
become badly ulcerated — 

Take 

Chlorate of potash ^ oz. 

Tannic acid % oz. 

Warm water 4 oz. 

Mix. 

And use as gargle thrice daily. Apply pure tan- 
nic acid to ulcers. Take compound syrup of 
rhubarb and potash, one teaspoonful three times 
daily, before meals, or half teaspoonful of syrup 
of iodide of iron. 

TOOTHACHE. 

A tooth consists of a hollow central cavity, 
filled with pulp of connective tissue, nerves and 
vessels: the body of the tooth is composed of 
ivory or dentine, and has an outside casing of 
enamel above the gum and common bone below. 

Toothache may occur from softening and 
decay of the dentine, which causes great pain 
when it reaches the pulp. The cause may be 
hereditary constitution, continued use of acids 
without washing the mouth after each dose, or 
of mercury (see poisons), or indigestion. 

Treatment — Removal of the decayed portion 
and tilling. A good temporary treatment is a 
smart purgative. 

Toothache from inflammation of the pulp may 
occur from irritation of food or of hot or cold 
liquids when the pulp is bare. It may also occur 
by reflex action, from cold to the feet 



864 Dr. J. Kean's Lectures. 

If the pulp is bare, a drop of carbolic acid on 
a glass rod or piece of wood to be applied to the 
pulp, a piece of cotton soaked in creosote, oil of 
cloves, or almost any essential oil applied to the 
pulp. Where there is no cavity a hot foot-bath 
and a purgative. 

Toothache from decay of the fangs causes fre- 
quent abscess and thickening. Have it extracted. 

Toothache from neuralgia (see Neuralgia). 

GLOSSITIS 

(Inflammation of the Tongue) 

Is a rare disease. There is pain, heat, salivation, 

and fever. The tongue is dark red, and may be 

covered with a thick slimy mucus. 

Treatment. — The bowels should be freely 
opened by castor oil ; if there is much swelling 
incisions along the top of the tongue to relieve 
the swelling. 

Cracked Tongue — Generally from indigestion ; 
there may be several cracks upon the upper sur- 
face of the tongue, rendering eating and speaking 
painful. 

Treatment. — (See Tonsillitis.) 

Ranula — A semi-transparent swelling under 
the tongue, containing a glairy fluid, due to ob- 
struction of the salivary duct from the gland 
under the chin. 

Treatment. — Excision of a part of the wall 
of the swelling by a surgeon of reputed skill, who 



Tonsillitis. 365 

is a graduate of a recognized college of medicine 
and surgery. 

Ulcers of the Tongue. — There are several varie- 
ties, most of which are very painful and difficult 
to heal, and occasionally may be the beginning 
of grave diseases of a cancerous nature. The 
whole of the top of the tongue may be super- 
ficially ulcerated in exhausting diseases or long- 
continued indigestion. 

Treatment. — Borax and honey frequently 
applied. 

Ulcers the result of simple inflammation are 
usually small, superficial, very sensitive, and near 
the top of the tongue. 

Treatment. — Milk diet (see Tonsillitis). Ex- 
traction of any teeth that may be causing irrita- 
tion. 

Scrofulous and syphilitic ulcers require to be 
treated for the cause (see Gr. B. published separ- 
ately). 

TONSILLITIS 
(Quinsy) 
Is an acute inflammation of the tonsils (glands in 
the throat, one on each side of the uvula) which 
may or may not lead to suppuration. It is 
most frequently caused by exposure to cold. 
Some people are much more liable to quinsy 
than others, and a person who has had one 
attack rarely escapes another, the liability to 
quinsy being increased by repeated attacks. It 



366 Dr. J. Kearts Lectures. 

is rare in children, and is chiefly confined to 
youth and middle life, especially in adults with 
enlarged tonsils, and prevails most in spring and 
autumn. The inflammation is usually preceded 
for some hours by chills and fever succeeded by 
a soreness in the throat and some difficulty in 
swallowing. The patient feels as if there was a 
foreign body in the throat [see Fig. 42], hence he 
makes constant attempts to swallow, though the 



Fig. 42.— Tonsillitis (Quinsy). 

motion increases the pain. The symptoms rap- 
idly increase, swallowing causing great pain, and 
on attempting to drink liquids they are returned 
through the nostrils. There is a continuous dull 
aching when the throat is at rest, the voice be- 
comes nasal, and the patient can hardly breathe 
except through the nose. There is usually a con- 



Tonsillitis. 367 

stant flow of saliva, and there may be earache, or 
a piercing pain extending to the ear accompa- 
nied by deafness, from the inflammation involv- 
ing the Eustachian tube, which leads from the 
top of the throat at the back of the nose to the in- 
ner cavity of the ear inside the drum. The 
mouth can only be partly opened, and that with 
pain and difficulty, the tongue is thickly coated 
and the odor offensive. Externally there is a 
painful swelling behind and below the angle of 
the lower jaw. These symptoms, along with loss 
of appetite, fever, and headache, continue in- 
creasing till the inflammation subsides, or the 
pus escapes. The fever and prostration are quite 
out of proportion to the severity of the local affec- 
tion. The temperature may be 104° F. or more, 
and there may be sleeplessness or even delirium. 
When the abscess opens the pus may be swal- 
lowed, and the patient perceive it only by the 
sudden relief of all the symptoms. The attack 
generally subsides in a week, and rarely lasts 
two. If suppuration has once occurred, subse- 
quent attacks rarely escape the same result. 

TREATMENT. 

Take 

Carbonate of ammonia 3€ oz - 

Tincture of capsicum % oz. 

Water 4 oz. 

Mix. 

Dose. — One teaspoonful thrice daily. Use 
warm drinks freely and avoid cold air. Use the 



368 Dr. J. Keari's Lectures. 

following application externally to throat until 
the case is completely cured. 

Take 

Muriate of ammonia J£ oz - 

Fluid extract of belladonna 10 drops. 

Warm water 3 oz. 

Mix. 

If near a surgeon of reputed skill, who is a 
graduate of a recognized college of medicine and 
surgery, the abscess may be opened, but it is dan- 
gerous to attempt it without knowledge of the 
part. 

Chronic inflammation of the tonsils — May result 
from quinsy or appear gradually, chiefly in scrof- 
ulous children and women, causing deafness, 
thickness of speech, difficulty of swallowing, and 
preventing the breathing. 

Treatment. — Gargles of tannic acid, 3 grains 
to an ounce of water ; iodide of potassium, 3 
grains twice a day for a w^eek or two. If these 
remedies fail, part of the glands may be cut oft 
by a surgeon of reputed skill, who is a graduate 
of a recognized college of medicine and surgery. 

PHARYNGITIS 

(Inflammation op the Throat) 
Maybe acute or chronic. Acute inflammation is 
comparatively rare, and is usually accompanied 
by considerable swelling. The symptoms are fe- 
ver, dryness of the throat, great pain in the com- 
mencement and difficulty in swallowing ; and 



(Es&pTuigitis. 369 

there may be more or less difficulty in breathing, 
the voice become nasal, the patient speaking 
through his nose and becoming unable to pro- 
nounce the letter R from swelling of the uvula. The 
tongue being coated, the breath foul, the mouth 
has a bad taste and is full of saliva ; there may be 
deafness and piercing pain extending to the ears. 
In very severe cases food may lodge after get- 
ting to the root of the tongue, the patient being 
unable to pass it either backwards or forwards, 
from the inflammation paralyzing the muscles of 
the throat. The affection is attended with great 
and rapidly-increasing prostration, but usually 
terminates in recovery in a few days. 

rp t. TREATMENT. 

Carbonate of ammonia }£ oz. 

Tincture of capsicum 3^ oz - 

Water 4 oz. 

Mix. 

Dose — Two teaspoonfuls thrice daily. Use 
warm drinks freely and avoid cold air. Use the 
following application externally to throat until 
the case is completely cured : 

Take 

Muriate of ammonia 3€ oz - 

Fluid extract of belladonna 10 drops. 

Warm water 3 oz. 

Mix. 

OESOPHAGITIS 

(Inflammation of the Gullet) 
Is generally from wounds or irritating substances. 
There is fever, burning pain shooting from the 

24 



370 Dr. J. Kearts Lectures, 

throat to the shoulder, difficulty in swallowing, 
coughing and constipation. Treatment consists 
in applying hot fomentations to the throat, and 
rest. Stricture of the oesophagus requires surgi- 
cal treatment. 

INDIGESTION OR DYSPEPSIA. 

Faulty digestion is one of the most common of 
all ailments, and though rarely causing direct 
danger to life, it is a source of discomfort which 
often renders life a burden. 

The predisposition to indigestion varies with 
the individual, and even in the same person it 
varies according to the general health. In some 
persons it is induced by causes which would have 
no effect on others. In many there is an heredi- 
tary tendency to indigestion, and in all one attack 
renders the patient more liable to another. 

We shall first consider the natural process of 
digestion in order to have a better understanding 
of the causes of faulty digestion. 

All kinds of food may be divided into three 
classes : 

1. Nitrogenous, principally albumen, fibrin, 
and casein. Albumen being largely present in 
the juices of almost all vegetables, in eggs and 
flesh ; fibrin or gluten in wheat and seeds and in 
flesh ; casein in peas, potatoes, etc., and the cheese 
of milk. 

2. Fatty, comprising animal fats and oils, with 



Indigestion or Dyspepsia. 371 

starch, gum and sugar, which are readily con- 
verted into fat. 

3. Mineral salts, chiefly phosphate of lime and 
common salt. Water, which constitutes four- 
fifths of the weight of the body, and air are both 
necessary for existence, but are not food in the 
usual sense. 

To preserve life and health there must be a due 
proportion of food from each of the three groups. 
No number of substances belonging to one group 
will preserve life ; thus criminals fed on starch, 
sugar, gum, butter and oil, died in a little 
more than a month. A diet of white bread 
and gelatin, with water, produces death from 
starvation, but a little brown soup added ren- 
ders it highly nourishing, showing that one 
substance, even though containing prinicples 
of the three groups, does not preserve life. 

The typical food, milk, which is the only sub- 
stance on which it is possible to maintain life 
and health alone, contains nitrogenous matter in 
the cheese, fatty in the butter contained in it, and 
mineral salts in the whey. 

The natural instinct of our appetites has ar- 
ranged the different articles of food in the most 
scientific manner ; thus, ham and fowl, pork and 
beans, potatoes and beef, bread and butter ; the 
nitrogenous principles of the one being balanced 
by the fat of the other. 

An able-bodied workingman requires about 



372 Dr. J. Kearts Lectures. 

thirty-five ounces of dry nutritious food daily, 
forming about six to seven pounds of mixed solid 
and liquid. Food should be well cooked and 
varied, the flavors exciting the flow of saliva and 
digestive juices, thus rendering it more digestible. 

In the mouth the food when masticated is 
mixed with the saliva which assists in breaking 
it down and facilitates swallowing by moistening 
the food, besides which it has a chemical action 
changing starch into sugar by an active principle 
called ptyalin. Probably none of the secretions 
is more easily influenced by the emotions than 
the saliva ; even the thought of a feast makes the 
mouth water, while dryness of the mouth is a 
symptom of terror or anxiety. 

Bolting the food, besides leaving it in masses, 
excites less saliva, and hence causes undue labor 
to the stomach. The action of chewing, pleasant 
emotions and flavors of food, all excite the flow 
of saliva ; hence, food should be well cooked and 
eaten slowly in pleasant company. After the 
food has reached the root of the toDgue, it is 
beyond the power of the will, and is carried to 
the stomach by a continuous wave of motion in 
the oesophagus (gullet). The stomach lies across 
the body and holds about five pints in an adult 
male. It is composed of a mucous coat internally, 
a muscular coat in the middle, and a serous coat 
outside. 

When the food arrives in the stomach it is 



Indigestion or Dyspepsia. 373 

pushed from left to right along the lower and 
longer border of the stomach, and then from 
right to left along the upper and shorter border. 

This circulating movement continues until the 
food is broken down into a fine pulp, of a strong 
acid taste and smell, called chyme, when it passes 
out into the bowels. During digestion the stom- 
ach is very irritable, and remains firmly closed, 
so that nothing but the finest pulp can pass out ; 
but after digestion is over undigested masses of 
food, and even large bodies, can pass through. 
The membrane of the stomach contains numerous 
small glands, which secrete an acid fluid, the 
gastric juice, the active principle of which is 
called pepsin, and has a powerful dissolving 
action on the nitrogenous parts of food, but 
merely liquefies the fat. As soon as a part of the 
food is digested, it passes out of the stomach, 
leaving the remainder freely exposed to the gas- 
tric juice. The digestive action of pepsin con- 
tinues out of the body in a vessel kept at 100° F., 
but takes three times as long, from want of the 
muscular movements, to break down and mix 
the food, and the dissolved parts remain to inter- 
cept the action on the remainder of the food. 

The blood vessels of the stomach absorb di- 
rectly liquids and anything dissolved in them 
such as salt or sugar, but not things merely 
mixed or suspended in the fluid; for example, 
the water of soups is absorbed directly by the 



374 Dr. J. Komi's Lectures. 

vessels, leaving the thick residue to be acted on 
by the gastric juice, and firm enough to be 
affected by the movements of the stomach, which, 
after absorbing the fluids, prepares the solids for 
the bowels, where the digestible portion of them 
is absorbed. When the fluid chyme leaves the 
stomach, it becomes mixed with bile from the 
liver, which arrests the action of the gastric juice, 
so that if any bile gets back into the stomach it 
arrests digestion and causes bilious vomiting. 
The bile acts as a natural purgative and anti- 
septic, besides helping the absorption of fat. 
The pancreas (sweetbread) adds a fluid the active 
principle of which, pancreatin, breaks up fat into 
an emulsion (cream is an emulsion of butter), and 
allows it to become absorbed by the lacteals. 
The small bowel is lined inside by numerous 
villi, which are small projections like the finger 
of a glove, and each of which contains minute 
blood vessels, and one or more lacteals or diges- 
tive vessels. The blood vessels absorb everything 
indiscriminately which can enter through their 
walls, but the lacteals select their materials, re- 
fusing to absorb many things which are taken 
up by the blood vessels. The muscular contrac- 
tion of the bowels forces the food against the villi 
containing lacteals and blood vessels, by which 
it is absorbed. There are also various glands in 
the bowels which secrete a small amount of juice 
which assists in the completion of digestion. 



Indigestion or Dyspepsia. 375 

The fluid in the digestive vessels at first some- 
what resembles milk, and is called chyle, which, 
after passing through several glands gradually 
becomes like blood, and is finally passed into the 
blood by the main trunk of the digestive vessels 
or thoracic duct. All the various processes are 
necessary to, and assist one another. The saliva 
when swallowed, stimulates the secretion of the 
gastric juice, and this in turn stimulates the flow 
of bile, pancreatic and intestinal juice. The 
conditions favorable to digestion are a moderate 
quantity of food, the stomach free of the last 
meal, tranquil state of mind, and good bodily 
health. Indigestion may be caused by anything 
which disturbs the natural balance of the dif- 
ferent actions. 

The causes of indigestion are various, and it is 
often difficult to tell whether a given symptom is 
a cause or an effect; for example, mental depres- 
sion causes indigestion, while indigestion almost 
always causes low spirits. The symptoms of 
indigestion may be due to chronic inflammation 
of the stomach (acute inflammation is not con- 
sidered), or to irritation which may or may not 
lead to inflammation. The principal causes, 
remembering that there may be more than one 
cause, may be arranged as follows : 

Scanty Gastric Juice. — The chief evil of de- 
ficient gastric juice is not that some of the food 
gives no nourishment, but that fermentative 



370 Dr. J. Kean's Lectures. 

changes take place, and cause irritation of the 
stomach, and the gases evolved cause distension 
of the walls, thus preventing the muscular move- 
ments and aggravating the evil. Fermentation 
and putrefaction, it is well known, occur much 
more rapidly in closed vessels at a uniform 
moderate temperature, both of which conditions 
are realized in the stomach. It is probable that 
there are thousands of different organisms 
(germs) which in their growth cause the different 
putrefactive and fermentative changes; each one 
always causing the same effect, at most in the 
same kind of substance, and that the different 
odors and changes in putrefaction vary according 
to the presence or absence of some of them. 
Familiar examples are seen in various ferments, 
such as sour milk, etc. A small quantity of sour 
milk turns gallons sour; the organism in these 
cases is known, and the resulting changes can be 
certainly predicted. The presence of organisms 
cannot in all cases be inferred with certainty 
from such changes alone, there being a remark- 
able class of chemical bodies which have the 
power of causing changes in other substances 
without themselves undergoing decomposition: 
this is termed catalytic action ; but it differs from 
the vital action of germs in the important point 
that the substance does not itself increase ; hence 
we take a little of the first solution and add it 
to fresh quantity of the material operated on, the 



Indigestion or Dyspepsia. 377 

change takes place much more slowly, and by 
repeating the process the effect rapidly reaches a 
vanishing point where no perceptible action takes 
place, while with the vital action of germs, 
which reproduce themselves, the change in the last 
solution takes place as quickly as in the first. 
The gastric juice is a powerful natural antiseptic, 
i. e. destroys and prevents the growth of organ- 
isms, as well as acting chemically on the food ; 
hence when it is deficient or too dilute fermenta- 
tion is possible and generally takes place. The 
deficiency may be due to fevers and acute inflam- 
mations, such as pneumonia, probably owing to 
the amount of water lost by the skin and lungs, 
causing less juice to be secreted, and which led 
to the erroneous maxim "starve a fever;" the 
proper treatment being to feed a fever with 
digestible food in small quantities at a time, so 
that less juice is required, and the food is quickly 
changed, preventing fermentation and indiges- 
tion. In scarlet fever, and also in small pox, 
measles, and perhaps some other fevers, the 
peptic glands of the stomach become inflamed, 
and hence the supply of gastric juice becomes 
lessened. Bloodlessness and general debility. 
All the fluids of the body are deteriorated, and 
the gastric juice participates in the deterioration, 
being deficient in the active principle pepsin. 
For this reason people in ill health, or weakly 
people, especially children, are unable to digest 



378 Dr. J. Kean's Lectures. 

the food which is easily taken and of benefit to 
those in good health. (Treatment by pepsin.) 

Too much food taken at a time, which is the 
same in effect as a deficient supply of gastric 
juice. This is most frequently seen in infants, 
though adults also take more than enough, especi- 
ally at public dinners, and generally suffer from 
indigestion next day in consequence. Infants 
will almost always take nourishment as often as 
it is given them, hence when the supply of milk 
is abundant they generally drink till the stomach 
is over-filled. If they vomit readily the surplus 
is removed and they readily digest and thrive on 
what remains. If they do not vomit readily the 
stomach remains over-filled, causing indigestion. 

Food which is beginning to decompose. 
Where there is powerful digestion there may be 
enough gastric juice and muscular action to dis- 
solve the food quickly and check the progress of 
putrefaction; thorough cooking also, by killing 
most of the germs, allows the stomach a fair 
start; hence high game when well cooked is 
actually more digestible, provided no irritant 
chemical products are evolved, part of the dis- 
solving action being already accomplished. The 
most common source of injury from this cause is 
in rearing children by hand. A child that is 
nursed obtains its milk free from germs except 
such as may be in its mouth, so the stomach has 
an opportunity of digesting the milk before germ 



Indigestion or Dyspepsia. 379 

changes take place; but with a child reared by 
hand, as a rule the milk has had abundant oppor- 
tunity to become filled with germs, often with the 
special germs which grow most quickly and 
vigorously in milk. The food being generally 
kept in a warm room, is at the temperature most 
favorable to germ growth, and the smallest trace 
of the former supply of milk which has turned 
sour, either in the bottle or in the child's mouth, is 
sufficient to cause rapid fermentation. We know 
how carefully dairy-keepers scald and cleanse 
their milk pans, especially in hot weather, to pre- 
vent the milk spoiling, yet how few mothers or 
nurses are equally diligent in cleansing the 
feeding bottle and wiping out the mouth of their 
charges, though, as before mentioned a vigorous 
child may thrive despite of considerable careless- 
ness merely because it takes a great deal of 
killing. 

Insufficient Division. — The gastric juice may be 
normal or even increased in amount but from 
the food being hard and indigestible, or from 
deficiency of muscular movements, the juice is 
unable to penetrate and dissolve the food, the 
centre parts of which may decompose, causing 
the usual fermentation changes, or the food may 
lie unchanged, feeling as a heavy weight at the 
stomach from direct irritation. 

Swallowing the food iu sufficiently masticated, 
either from bolting the food or from want of 



380 Dr. J. Kean's Lectures. 

teeth. Consequently the larger masses offer little 
surface for the gastric juice to act on, and while 
the outside of the mass may be digested the inside 
is untouched and ferments. From this we see 
the importance of preserving the teeth and eating 
slowly. The teeth should be brushed at least once 
a day, clearing away the minute particles of 
food which remain in the interstices and other- 
wise undergo fermentative changes leading 
to the decay and destruction of the teeth much 
as mites destroy cheese. One of the best tooth 
powders is ponderous magnesia, which is a 
soft mild alkali, and may be scented and flavored 
to taste. Vegetable food requires more ptyalin to 
convert the starch into sugar than animal food, 
and hence requires more chewing. Swallowing 
masses of fat or in a form in which when melted 
it can run together, retards digestion, and the 
acrid matters produced cause great irritation ; to 
prevent which fat should be given finely divided, 
a familiar example of which is seen in bread and 
butter. If the butter were taken alone it would 
almost certainly cause sickness, while along 
with bread it is comparatively easily digested, 
the bread crumb preventing its running together 
in the stomach, and causing it to present a very 
large surface for the action of the gastric juice. 
In the same manner fat meat or gravy should be 
mashed up with potato or bread. 
Too much liquid at meal times dilutes the 



Faulty Innervation. 381 

gastric juice, rendering its action slower, and im- 
pairs the muscular movements by over-distension. 
Deficient muscular action from any causes 
lessens the digestive power. The food is no 
longer rubbed down mechanically nor the outer 
part rubbed off when softened, thus exposing a 
fresh surface to the gastric juice; hence the juice 
accumulates from want of sufficient surface to 
use it all, and acting as an irritant to the stomach 
it causes vomiting, in which it is ejected along 
with the almost unaltered food. This is the chief 
cause of the indigestion generally following full 
doses of narcotic remedies such as opium, chlo- 
ral, chloroform, etc., and in a less degree even 
from smoking tobacco. 

FAULTY INNERVATION. 
(Deficient Nervous Energy.) 

If after a full meal we at once begin severe 
mental or physical work, the nervous energy is 
diverted from the stomach to the brain or muscles, 
thus slowing the muscular movements of the 
stomach, and similarly the blood supply is also 
diverted, causing a scanty secretion of gastric 
juice. For the same reason continued mental 
depression, long-continued night-watching, severe 
exhaustion, or sudden mental excitement, as great 
joy or grief, diminish the secretions and destroy 
appetite. 

Slow Digestion may be due to a naturally small 



382 Dr. J. Keantis Lectures. 

supply of blood causing a scanty secretion of 
gastric juice, or to deficient muscular action from 
relaxed feeble state of the muscular fibres. 

Reflex disturbance of the nervous supply may 
occur from disease of the brain, womb or liver. 

Neuralgia of the nerves of the stomach may 
prevent the muscular movements and the secre- 
tion of gastric juice. 

CHRONIC INFLAMMATION. 

The preceding causes are generally in the first 
instance unaccompanied by inflammation of the 
stomach and may never extend to it. 

The succeeding causes produce chronic inflam- 
mation of the stomach (chronic gastritis), the 
prominent symptoms of which are those of indi- 
gestion and which may be the cause or the con- 
sequence of the inflammation ; for acute inflam- 
mation see Gastritis and Biliousness. 

Direct irritation of the mucous membrane of 
the stomach leading to chronic inflammation 
greatly diminishes the secretion of gastric juice, 
and if severe also impedes the muscular move- 
ments both by direct action on the muscles, and 
by deranging the nervous supply. The most 
usual forms of irritation are from abuse of spirits, 
very hot or cold drinks, strong medicines, im- 
moderate use of condiments such as pickles, pep- 
per, spices, hot sauces, or highly salted food, such 
as salt pork. 



Chronic Inflammation. 383 

Over-secretion of gastric juice, the surplus act- 
ing as a direct irritant to the stomach. 

Secondary to disease of the heart, lungs, 
liver or kidneys, the mucous membrane of the 
stomach becoming gorged or congested from me- 
chanical arrestment of the circulation; carbonic 
acid accumulates in the blood, and the gorged 
vessels cannot absorb fluid from the stomach, nor 
the gastric glands secrete juice from want of 
fresh blood to supply them ; after a time the part, 
becoming weakened and irritated by fermentative 
changes, assumes a state of chronic inflammation. 

Secondary to diseases and affections of the 
bowels and digesting glands, such as consti- 
pation, congestion of the liver, obstruction of 
the bowels, etc. 

Symptoms — Vary considerably both in nature 
and severity, according to the cause of indiges- 
tion, and even from the same cause. When the 
cause is scanty secretion of gastric juice, there 
is prolonged distress after eating, a feeling of 
weight and uneasiness of the stomach, flatulence 
and evolution of gases, sour eructations, irregular 
action of the bowels, and some of the food passes 
unchanged. 

If the cause is indigestible food or weakened 
movements of the stomach, in addition to the 
symptoms already mentioned, there is generally 
a great tendency to vomiting and heartburn, 
which is eructation of a watery acid or insipid 



384 Dr. J. Kean's Lectures. 

fluid, and may be accompanied by pain of a 
burning kind. 

When due to faulty nervous supply, the pain 
is often severe and is relieved by pressure, and is 
not unfrequently accompanied by severe head- 
ache and palpitation of the heart. 

When due to chronic inflammation (gastritis), 
there is headache and a feeling of tightness 
across the forehead, flashes before the eyes, pain 
and swelling of the stomach, along with a feeling 
of sickness, but which does not generally ter- 
minate in vomiting, heartburn and eructation of 
gases. The tongue is usually red at the tip and 
edges, coated with a creamy white fur, and the 
breath offensive, having a peculiar odor of phos- 
phorus. The pain in the stomach is often mo- 
mentarily relieved by eating, hence there may be 
a voracious appetite. The mental depression is 
generally greater than in other forms of indi- 
gestion, and when long continued there is gen- 
erally redness of the tip of the nose. 

In all forms of indigestion there is more or less 
mental depression, headache, giddiness, and pal- 
pitation of the heart, along with disturbed sleep, 
fearful dreams or nightmare, loss of appetite, 
flatulence, and often nervous pains in the head, 
limbs or chest, a bitter or slimy taste in the 
mouth, and after long continuance there may be 
more or less emaciation. 

As a rule, the tongue shows the state of the 



Chronic Inflammation. 385 

stomach, becoming furred and causing bad taste 
in the mouth, along with an offensive odor, when 
the mucous membrane of the stomach is dis- 
ordered ; the state of inflammation probably ex- 
tending up the membrane of the oesophagus 
(gullet) to the tongue. A less obvious connection 
exists between the state of the stomach and the 
skin of the tip of the nose, in many persons 
increased irritation and inflammation of the 
stomach is unfailingly shown by increased red- 
ness of the nose. Confirmed inebriates, whose 
stomachs are in a state of chronic inflammation, 
from constant irritation of spirituous liquors, have 
generally a red nose, the color varying from a 
bright-red to a purplish tint. 

The urine is generally high colored, and de- 
posits a reddish sediment (urates). 

Indigestion is rarely fatal, but is often of very 
long continuance, especially chronic inflamma- 
tion. 

Treatment. — The food should be of the most 
easily digestible kind, and given in rather small 
quantities at a time, at intervals of two or three 
hours. It should be very thoroughly masticated, 
both to break it down and to increase the flow of 
saliva. If the teeth are lost, artificial ones should 
be inserted. 

It must be remembered that food may be very 
easily digested and yet contain but little nourish- 
ment, while indigestible food may be very nour- 

25 



386 Dr. J. Kean's Lectures. 

ishing when absorbed. Old people should have 
food that is easily soluble, because the juices and 
movements are lessened. The general health 
must be attended to that a sufficient supply of ner- 
vous energy may be available. There must be 
rest from business or severe studies, exercise in 
the open air, cold bathing in suitable cases, or a 
wet compress over the stomach consisting of 
four folds of linen wrung out of cold water and 
covered with a dry cloth and piece of waterproof; 
the reaction when it warms draws blood to the 
stomach, and increases the supply of secretions. 
In indigestion from scanty gastric juice a moder- 
ate allowance of wine or weak brandy and 
water, one tablespoonful to a tumbler of water, is 
of use, alcohol being both a stimulant to the se- 
creting glands and an antiseptic. In convales- 
cence from fevers, and in general bloodlessness, 
light wines are to be preferred. Pepsin should be 
taken before meals, 10 grains at a time, to supply 
artificial gastric juice, particularly in fevers, 
where as much as 15 to 20 grains a day may be 
given. Meat and eggs should not be over-cooked. 
Alkalies may be taken to facilitate the digestion in 
the bowels [see Alkaline Springs, Lecture XVI], 
a tumblerful of equal parts milk and lime-water, 
or a glass of soda-water alternating every week 
with potash-water, after dinner. If the bile is 
also deficient, which is shown by clay-colored 
stools, increase its flow by — 



Chronic Inflammation. 387 

Take 

Powdered podophyllin 2 grains. 

Powdered leptandrin 10 grains. 

Mix. 

Make twenty powders. 

Dose — One, night and morning [see Precau- 
tionary Rules, Lecture XVII]. 

When indigestion proceeds from errors in diet, 
bolting the food, too much food or drink, narcotic 
medicines, or smoking, these indiscretions must 
be abandoned, when it will probably cease. De- 
ficient muscular movements require the same 
treatment as slow digestion. 

When indigestion proceeds from deficient ner- 
vous energy, attention to the general health, rest 
after meals, and a moderate amount of wine 
or dilute spirits. When from slow digestion, 
which is very common after middle age, a table- 
spoonful of spirits in a tumbler of water, and the 
following digestive tonic : pepsin, 5 grains ; or 
a dinner pill, to be taken every day half an hour 
before dinner. 

In painful digestion, 

Take 

Pepsin 30 grains. 

Subnitrate of bismuth 10 grains. 

Mix. 

Make six powders. 

Dose — One, three times a day at meal-times. 

In all the foregoing forms of indigestion where 
there is much acid eructation, charcoal, 12 grains 



388 Dr. J. Kean's Lectures, 

at a time, and 2 grains of creosote, half an hour 
after dinner, may give great relief. 

Acid indigestion felt about two hours after 
meals is relieved by alkalies such as soda. [See 
Alkaline Spring, LectureXVL] 

When indigestion is due to over-secretion of 
gastric juice, which is rare, a tumbler of soda- 
water will often suffice to correct it. 

In indigestion from chronic inflammation of 
the membrane of the stomach, the food must be 
sparing and easily digested, avoiding all season- 
ing except a small amount of salt. Thirst may 
be relieved by sucking small pieces of ice. 
Strong tea and coffee, which are frequent causes 
of this form of indigestion, must be avoided, , and 
a glass of boiled milk, which may have a third 
part of soda or potash-water added, combined 
with the foregoing treatment. 

Of ordinary animal food, Jbeef and mutton are 
the most nourishing, and when well cooked, par- 
ticularly roasted, are as digestible as any other. 
Roast is more digestible than boiled meat, and 
stewed is less so than either. It is easier for the 
stomach to digest a few different articles than to 
be restricted to the same amount of one. A little 
soup, white fish, and roast meat, is better than if 
the dinner had consisted of the same amount of 
beefsteak only. Of raw fruits, oranges and 
grapes, and of vegetables, asparagus and cauli- 
flower, are most easily taken. Light puddings 



Acute and Sub- Acute Gastritis. 389 

are a wholesome and digestible addition to din- 
ner, but pastry, dumplings, cheese, beer, port wine, 
and raw spirits are all to be avoided. By long 
custom a power may be acquired of digesting 
substances which at first could not be tolerated, 
and finally, personal peculiarities or idiosyncra- 
sies often have a great effect in rendering things 
digestible, indigestible, or even poisonous. 

Flannel should be worn next the skin both 
night and day, and damp feet guarded against. 

ACUTE AND SUB-ACUTE GASTRITIS. 

(Inflammation of the Stomach.) 
Acute seldom arises of itself, but is generally 
due to irritant poisons, such as mineral acids, 
raw spirits, or boiling water. There is burning 
pain over the stomach, which is increased on 
pressure, and spreading downwards, distressing 
sickness, violent vomiting an'd retching, quick 
pulse and breathing, along with fever. 
rp ak treatment. 

Tincture of gelsemium 60 drops. 

Tincture of aconite 20 drops. 

Water 4 oz. 

Mix. 

Dose — One teaspoonful every half hour. Also 
give decoction of peach-tree bark, one teaspoon- 
ful every hour. Apply the following over stomach : 

Take 

Spirits of turpentine % oz. 

Olive oil 2 oz. 

Mix. 




Fig. 43.-- -Ulcer op the Stomach. 



Chronic Ulcer of the Stomach. 391 

To remove pain, 

Take 

Morphine 3 grains. 

Water 2 oz. 

Mix. 

Dose — One teaspoonful every three hours. 

During convalescence, the food should consist 
solely of milk, and the various starches, wheat- 
flour, arrowroot, grated cracker, etc. 

Sub-acute. — There is headache, sickness, and 
vomiting, sensations of heat and cold, distaste for 
food, — even the presence of which often causes 
vomiting, the vomited matters being streaked 
with blood. 

There is more or less fever, hot skin, and quick 
pulse, foul tongue coated with white fur, a clam- 
my feeling ot the mouth, offensive breath, and 
eructation of acid fluid and gases. 

Treatment. — An emetic, rest, bland food, milk, 
wheat-flour, etc., in small quantities, fomentations 
over the stomach as hot as the patient can bear. 
[See Acute.] 

CHRONIC ULCER OF THE STOMACH 
Is rare before puberty, and occurs twice as often 
in women as in men, and more frequently among 
the poor than those in good circumstances. It is 
most frequently found in women between eight- 
een and twenty-five years of age, who are pale 
and comparatively bloodless [see Fig. 43]. The 
ulcer is generally about the size of a cent, round 
in shape, with sharp edges, and is caused by ob- 
struction of a small blood vessel leading to death 



392 Dr. J. Kean's Lectures. 

of the parts it supplied with blood. It may prove 
fatal by perforating the stomach, the contents of 
which escape and cause fatal inflammatioo (per- 
itonitis), or by loss of blood from the ulcer open- 
ing into a large blood vessel, or finally by ex- 
haustion. The symptoms vary in severity in 
different cases. Two to ten minutes after taking 
food there is a feeling of weight or tightness at 
the stomach, rapidly increasing into a burning 
or gnawing pain, increased by pressure and pro- 
duces a sense of sickening depression. The pain 
exists from half an hour to two hours, and is 
greater, continues longer, the coarser the food, 
bread and potatoes causing longer and severer 
pain than milk and corn-flour. When the stomach 
is emptied by vomiting which often occurs, the 
pain at once ceases. The tongue is generally red 
and furrowed, and acid eructations usually occur, 
accompanied by constipation and increased thirst. 
The course of chronic ulcer is almost always 
tedious, running for months or years, and re- 
lapses are not uncommon. In favorable cases 
the pain diminishes as the ulcer heals and there 
is complete recovery, or the scar of the ulcer may 
cause stricture of the stomach, which causes 
more or less suffering after a full meal, heart- 
burn and vomiting. The scar may become at- 
tached to some other organ and cause pain by 
interfering with the movements of the stomach 
during digestion. 



Hmmatemesis. 393 

Treatment. — Rest to the stomach and sooth- 
ing medicines. The food must be bland and 
taken in small quantities at a time. Iced milk, 
with a quarter of its bulk of lime-water, a wine- 
glassful at a time, small quantities of gruel, corn- 
flour, or grated cracker. 

Take 

Pepsin 20 grains. 

Subnitrate of bismuth 10 grains. 

Mix. 

Make six powders and take one thrice daily at 
meal times. 

In severe cases, complete rest to the stomach. 
The patient should be nourished by injections of 
milk, beef-tea, beaten-up eggs, and occasionally 
brandy; each injection must not exceed a small 
teacupful. Hot fomentations over the stomach. 
If the pain continues take morphine 3^ grain 
every three hours. 

ILEMATEMESIS 
(Vomiting of Blood) 
Is generally from an ulcer opening into an artery 
or vein, but it may also occur from congestion 
caused by disease of the liver, heart, or lungs, or 
without any special cause. After sickness for a 
little time, and a feeling of warm fluid rising in 
the throat with a sweetish taste, there is violent 
vomiting of blood, partly fluid and partly clotted, 
usually of a dark-brown color, and mixed with 
food. 



894 Dr. J. Kean's Lectures. 

Treatment. — Perfect rest lying down, cold 
over the stomach, swallowing small pieces of ice. 
Ligate (tie round) the limbs close to the body, as 
previously directed, and take dilute sulphuric 
acid, 10 drops, in a wineglassful of water, every 
hour if required. The patient must abstain from 
food for twenty-four hours. The food must consist 
chiefly of milk with one-third of lime-water. In 
the chronic form, gallic acid, 10 grains, every two 
hours, if required. 

CANCER OF THE STOMACH 
Occurs more frequently in men than in women, 
and is rare before the fortieth year of age [see 
Fig. 44]. Few survive beyond two years from 
the commencement of the complaint. The symp- 
toms are pain in the region of the stomach of a 
burning, cutting or gnawing character, which is 
increased by food or by pressing over the stomach. 
There is frequent vomiting, more frequent the 
nearer the cancer is to either of the openings of 
the stomach, of a glairy mucus and altered blood, 
having the appearance of coflee grounds. There 
is loss of appetite, sickness and eructation of foul 
gases. Along with these symptoms the patient 
rapidly loses strength, and acquires a character- 
istic dirty-yellow color of the face, and finally 
swelling of the ankles. The walls of the abdo- 
men are retracted, and a firm painful tumor the 
size of an apple, may be felt generally towards 



Cancer of the Stomach. 



395 



;he left side, pulsating when it lies over the main 
artery (aorta). 




Fig. 44.— Cancer of the Stomach. 
TREATMENT. 



rake- 



Morphine 3^ grain every three hours. 



rake- 



Tincture conium 1 oz. 

Fluid extract of belladonna % oz. 

Water 2 oz. 

Mix. 



396 Dr. J. Kearts Lectures. 

Dose — One teaspoonful thrice daily (see pre- 
cautionary rules, Lecture XVII). 

Apply hot fomentation over the stomach. 

The food must be small in quantity, nutritious 
and digestible, milk forming a large part. 

INFLAMMATION OF THE BOWELS. 
Inflammation very rarely affects the whole 
length of the bowels, and the farther it recedes 
from the stomach the more apt is it to be affected. 
The inflammation varies very much in severity 
and in consequent symptoms. When confined to 
the short part of the bowel (duodenum) near the 
stomach it is often spoken of as a bilious attack, 
because there are vomiting and purging of bile, 
not because more bile is secreted, but it is not 
reabsorbed. When bile gains admission to the 
stomach it neutralizes the gastric juice and diges- 
tion ceases ; the undigested food then acts as an 
irritant and causes vomiting. When the small 
bowel is affected (enteritis) there is generally 
pain, flatulence and diarrhoea at first of thin ordi- 
nary stools, but, after the bowel is emptied, of 
watery fluid secreted from the blood, just as a 
cold increases the secretion from the nose. The 
color of the stools is usually green from bile, 
the action of the bowels being hastened and 
absorption hindered so that the bile passes un- 
altered. When there is profuse diarrhoea the bile 
is unable to color it all, hence the stools be- 



Inflammation of the Bmrels. 397 

ome gradually paler. Diarrhoea may be absent 
rom the first owing to the reabsorption of the 
luid by the larger bowel. Flatulence and rumb- 
ing in the intestines are caused by the gases 
rom decomposing food or mucus, and are re- 
ieved by eructations. The pain is usually felt 
ound the navel and is relieved by pressure, and 
ubsides for a time just before and after a stool. 
^s the inflammation increases the muscular 
ibres of the bowels are paralyzed or impeded, 
causing obstinate constipation. There is also 
ickness and vomiting, the vomited matter 
gradually acquiring the offensive odor of the 
tools, accompanied by thirst, hot skin, anxious 
countenance, and fever which may extend to 
lelirium. 

Chronic inflammation in adults is rarely ac- 
companied by diarrhoea, but usually by more or 
ess constipation, the abdomen becoming tense 
md interfering with the circulation and breathi- 
ng. The tough mucus secreted hinders nutrition, 
md by decomposing causes flatulence; hence 
n time the patient becomes weakened and 
emaciated. 

Chronic inflammation in children shows itself 
is an obstinate and exhausting diarrhoea. 

The causes of inflammation of the small bowel 
nay be secondary to some disease of the liver, 
leart or lungs, causing increased blood pressure 
congestion) going on to inflammation. It may be 



398 Dr. J. Kean's Lectures. 

direct from irritating purgatives or food, usually- 
vegetable, or it may be reflex from sudden expo- 
sure of the skin to prolonged cold, or great heat 
as in extensive burns. 

Inflammation of the lower bowel (typhlitis) is 
usually caused by accumulations of undigested 
food, such as skins and stones of fruit. The mus- 
cular fibres become paralyzed, causing constipa- 
tion, mucus or blood and mucus passes at stool, 
but no proper evacuation. There is fever, sick- 
ness and vomiting, with tenderness on the right 
side greatly increased by pressure. 

The inflated intestine can be felt between the 
right hip and lower ribs. The pain often extends 
down the thigh and is marked by severe par- 
oxysms, with intervals of comparative ease. All 
these symptoms, although severe, may pass away 
after several lumps of hardened faeces have been 



In chronic inflammation the symptoms appear 
gradually, with failing health, weakness, loss of 
appetite, flatulence, pains in the right side, and 
alternate diarrhoea and constipation. 

Treatment. — In inflammation of the upper 
part of the intestines (so-called bilious attacks) 
complete rest in a darkened room, with free 
ventilation, total abstinence from food and drink, 
except taking small pieces of ice, to relieve 
thirst and vomiting. 



Dysentery. 399 

Take 

Powdered hydrastis 100 grains. 

Subnitrate of bismuth 10 grains. 

Mix. 

Make ten powders. 

Dose — One powder thrice daily ; continue for a 
few days ; the following to remove pain if severe : 

Take 

Sulphate of morphia J£ grain thrice daily. 
The attack usually ceases in two to five days. 
As vomiting subsides give small quantities of 
milk ; other food, fresh oysters or mutton, given 
as the symptoms disappear. For inflammation 
generally, when acute, cold compresses over the 
abdomen. When chronic, apply hot fomenta- 
tion or 

Take 

Spirits of turpentine.. % oz. 

Olive oil 2 oz. 

Mix. 

And apply to abdomen, and give a gentle cath- 
artic in this stage, but not in the acute, as strong 
purgatives are pernicious, as th,e muscular fibres 
of the bowel are already paralyzed by inflamma- 
tion, which the action of purgatives increases. 

In inflammation of the lower bowel (typhlitis), 
a single full dose of castor oil — two tablespoon- 
fuls. Injection of warm water with lobelia 20 
drops. 

DYSENTERY 
Is an infectious fever whose germs multiply out 
of the body in like manner as yellow fever, 



400 Dr. J. K earl's Lectures. 

typhoid fever, and cholera. The duration and ef- 
fects vary very much, but it is much more common 
in tropical countries, especially in the South, and, 
like ague, the effects remain after leaving a tropi- 
cal country, and the attack recurs. 

The predisposing causes are somewhat like 
those of cholera — errors of diet, exposure to cold 
and wet, great fatigue, intemperance, bad drain- 
age, and filthy surroundings. The local affection 
is a specific inflammation of the mucous lining 
membrane of the large bowel accompanied by 
griping pain (tormina), straining, and small 
amounts of grey or bloody mucus, of a peculiar 
sickening odor, passed at each stool. Dysentery 
may be either acute or chronic. Acute may 
begin without premonitoiy symptoms, but gener- 
ally there is languor, loss of appetite, weakness, 
and diarrhoea, for twelve to twenty-four hours, 
when irregular shooting pains, or gripes, begin to. 
attend the discharges. After a short time a sensa- 
tion of heat ascends the bowel, and pain extends 
till the whole abdomen is painful. With frequent 
inclination to go to stool, more frequent in pro- 
portion to the severity of the disease, after 
much straining and griping pain, a small quan- 
tity of mucus or bloody slime is passed, affording 
momentary relief, but the pain speedily returns, 
accompanied by the exhausting sensation that, 
something remains in the bowel to be discharged. 
As the disease progresses the calls to stool become 



Dysentery. 401 

more frequent, and the intervals shorter, the pain 
concentrates near the lower end of the bowel 
(rectum), the stools have a peculiar offensive odor, 
and may contain hardened lumps of faeces, and 
after the eighth day shreds of fibrous membrane 
or occasionally pure blood. The symptoms are 
generally worse at night and early morning, with 
short periods of disturbed and unrefreshing 
sleep. A hot dry pungent skin, furred tongue, 
urgent .thirst, scanty high-colored urine, and 
increasingly quick pulse, are signs of increasing 
danger. Death may occur in the first twelve 
days, or a favorable change may appear from the 
sixth to the tenth day, the disease terminating in 
three or four weeks. Canvalescence is always 
slow from the great amount of albumen lost in 
the stools, and not un frequently there is dropsical 
swelling of the legs, as in Bright's disease. 

Treatment. — For prevention of dysenteiy pre- 
cautions are to be taken. Avoid indigestible 
food, exposure to cold and damp, or great fatigue. 
Use warm clothing and flannel next the skin ; the 
food must be nourishing — milk, eggs, beef-tea, 
etc. The acute form Should be attended to as 
early as possible. Let the patient rest in bed in a 
well-ventilated room, apply a hot poultice, or tur- 
pentine and oil, over the stomach. 
Take 

Castor oil 1 drachm. 

Tincture opium 20 drops. 

Mix. 

26 



402 Dr. J. Kean's Lectures. 

If relief does not quickly follow, then the sub- 
joined will effect a cure if persevered in: 
Take 

Tincture of kino % oz. 

Bicarbonate of sodu 3€ oz - 

Tincture of opium Ji oz. 

Essence of anise % oz. 

Syrup of orange peel 3 oz. 

Mix. 

Dose — One teaspoonful every hour ; or, 
Take 

Diaphoretic powder 3 grains. 

Powdered capsicum 1 grain. 

Every hoar, with alkaline drinks. 
Take 

Spirits of turpentine % oz. 

Olive oil 2 oz. 

Mix. 

And apply to the abdomen. (See precautionary 
rules, Lecture XVII.) 

Remain still in bed and abstain from all drink 
for three hours. Thirst may be relieved by taking 
small pieces of ice. The good effect is shown by 
the pain and straining subsiding ; the blood and 
slime disappear, the patient perspires profusely, 
falls into a tranquil sleep, and awakes refreshed. 
Severe pain and straining may be relieved 
by the hot bath. During convalescence milk 
should form a large part of the dietary, and 
return to ordinary food must be very cautiously 
made. 



Chronic Dysentery. 403 

CHRONIC DYSENTERY 
Is a most intractable form of disease, the morbid 
changes progressing slowly for months, diarrhoea 
alternating with constipation^ and ordinary stools 
with blood and slime. The patient steadily 
wastes till he becomes a living skeleton ; the skin 
becomes dry and covered with branny scales. In 
more than half the cases of dysentery there is 
also an affection of the liver. 

In the severer forms of both acute and chronic 
dysentery the lower bowel is lined by a false 
membrane as the throat is in diphtheria, parts of 
the lining membrane die from the violence of 
local inflammation and leave ulcers which may 
go on to perforation of the bowels. 
Treatment. 

Take 

Tincture of kino % oz. 

Bicarbonate of soda ^ oz. 

Tincture of opium \ oz. 

Essence of anise % oz. 

Syrup of orange peel 3 oz. 

Mix. 

Dose — One teaspoonful every hour. Alkaline 

drinks and capsicum, with diaphoretic powder. 

Apply the following to stomach and abdomen : 

Take 

Spirits turpentine % oz. 

Olive oil ..2 oz. 

Mix. 

Precautions as in acute. (See alkaline spring, 
Lecture XYI.) 



404 Dr. J. Kearts Lectures. 

MEL^ENA 
(Bleeding from the Bowels) 
May occur from ulcers in the bowels opening 
into blood vessels, which sometimes occurs in 
typhoid fever. From congestion of the lining 
mucous membrane, most frequently from, cirrhosis 
of the liver. Like bleeding from the nose, it may 
occur without any change of structure, which is 
seen in scurvy and yellow fever; from various 
inflammations and tumors. If the blood is not 
in large quantity it is passed like coffee grounds 
or like tar from the action of the digestive fluids. 
Treatment must vary according to the cause. 
Turpentine 10 drops, every half hour until the 
hemorrhage ceases, and gallic acid 4 grains, may 
also be given every second hour if required, so 
long as any blood appears in the stools. Other 
remedies are mineral acids and bitters. (See 
Bleeding prom the Lungs.) 

OBSTRUCTION OF THE BOWELS 

May be due to strangulation from bands of fibrin 
forming an internal rupture (hernia), to twisting 
of the bowel on itself, to strictures, tumors, gall- 
stones, or intussusception, which is when one 
part of the bowel is drawn in by the action of the 
part below ; the sheathing part of the bowel con- 
stricts the contained part, soon causing enormous 
swelling. The symptoms are sudden constipa- 



Obstruction of the Bowels. 405 

tion in a person hitherto healthy, with a sense of 
uneasiness and flatulence, after a time becoming 
a fixed pain ; the abdomen is distended, with roll- 
ing of the inflated bowels. Sickness and vomit- 
ing come on, and gradually increase till the vom- 
ited matters, at first greenish from bile, begin to 
have the odor and appearance of the stools. If 
the obstruction is complete, and the obstacle is 
not removed by nature (rarely before life is in ex- 
treme danger) or by art, the symptoms go on in- 
creasing and terminate fatally about the fifth 
day. When the symptoms subside, the pain, dis- 
tension, and vomiting rapidly cease, there are co- 
pious stools, and the patient is restored to health. 
The pain is most severe in intussusception, and 
least in stricture and impaction of faeces. 

In intussusception, the obstruction may not be 
complete, the inflated intestine may be felt in the 
abdomen, and the symptoms appear gradually, 
and may last a considerable time ; sometimes 
there is spontaneous cure by sloughing off of the 
enclosed bowel. When the obstruction is in the 
upper part of the bowel, vomiting begins early 
and is bilious, the abdomen is not much dis- 
tended, and the urine is scanty. When lower 
down in the large bowel, vomiting is later in be- 
ginning; at first bilious, it gradually becomes 
feculent. The abdomen is greatly distended, 
while the intestine is in great commotion by its 
peristaltic action. 



406 Dr. J. Kearts Lectures. 

Treatment. — Diminish the food and drink, 
giving merely iced fluid, warm fomentations over 
the abdomen ; position should be on the back 
with the limbs drawn up, use injections of the 
following : 

Take 

Olive oil K oz - 

>Yater 2 quarts. 

Mix. 

Or inflate the bowels with air. 

DIARRHCEA. 

Diarrhoea is a symptom rather than a disease of 
itself, and is often an effort of nature to get rid of 
some irritating substance in the bowels by wash- 
ing it away. The causes may be : 

Direct irritation of the bowels from indigesti- 
ble food, and from personal peculiarity (idiosyn- 
crasy). Some persons have diarrhoea from food 
which* is quite digestible to others ; for example, 
shellfish, pork, mushrooms, honey, etc. ; but cus- 
tom often brings tolerance of what caused much 
disturbance at first, such as acid wines and game. 
Impure water, raw vegetables, and unripe fruits 
are common causes, as well as mixed food and 
drink, which are tolerated separately, such as 
mixed malt liquor and wines, or even excess of 
digestible food. 

Various affections of the lining membrane of 
the bowels, chronic inflammation, ulceration 



Diarrho&a. 407 

of the follicles, and waxy degeneration of the 
bowels. 

Congestion from diseases of the heart, lungs, 
liver, or kidneys. 

Reflex diarrhoea, which may be due to mental 
emotions such as fear, anger, or excitement ; or 
to cold to the skin, exposure to wet, great fatigue ; 
or, in children, teething, which is a very com- 
mon cause. 

Along with the diarrhoea there may be : Sick- 
ness and vomiting, with flatulence, the tongue 
furred, the breath foul, and soreness increased on 
pressure over the abdomen ; or, 

The tongue may be clean, and nothing beyond 
the diarrhoea. In either case the stools may be 
black, yellow, green, white, or mixed with blood. 

Treatment. — When the tongue is clean and 
the pulse natural, a mild purgative should be 
given. If the complaint continues — 

Take 

Iodoform 30 grains. 

Gum arabic 20 grains. 

Mix. 

Make ten pills and take one, thrice daily, be- 
fore meals, or (see cholera prescription). 

In the great majority of cases one will suffice, 
but occasionally there are obstinate diarrhoeas 
which resist many remedies, and by continuance 
may imperil the patient's life. It is of great con- 
sequence, especially in severe cases, to keep the 
patient at absolute rest, lying down, and have 



408 Dr. J. Kean y s Lectures. 

warmth applied to the abdomen, as by hot fomen- 
tations succeeded by a mustard poultice. The 
food must be unirritating, such as milk, arrow- 
root, corn-starch, beef-tea, gruel, etc. Drink weak 
brandy and water, which is both an astringent 
and stimulant, and also prevents vomiting. 

COLIC 

Is a severe pain seated in the abdomen, caused 
by contraction of the muscular fibre of the bow- 
els from indigestion, or some irritant, or a general 
cause such as cold or lead. (See poisons.) 

The pain is of a sharp twisting nature, and is 
seated round the navel, it occurs in paroxysms, 
and the whole attack may last for a few minutes 
to hours, when it suddenly ceases. 

The bowels are generally, but not always, con- 
stipated, and there is often sickness and vom- 
iting, but no fever, hot skin, or quick pulse. 

Wind may be felt and heard moving in the 
bowels, causing excessive local distension and 
severe pain, which is relieved by pressure ; hence, 
the patient is doubled up or rolls about. The 
walls of the abdomen participate in the spasm, 
and are hard and tense, either drawn in, or, if 
there is much flatulence, distended. The bladder 
may participate in the spasms, the urine being 
frequently ejected or suppressed. 

Treatment. — A large hot poultice to the 
abdomen. 



Constipation and Costiveaess. 409 

Take 

Wild yam 2 oz. 

Boiling water 1 pint. 

Mix. 

Dose — A wineglassful, thrice daily, warm, ac- 
companied by alkaline drinks, — soda, potash, 
etc. (See alkaline spring, Lecture XVI.) 

CONSTIPATION AXD COSTIVEKESS. 

As a rule, most people go to stool eveiy day, 
but some only every second or third, or even 
longer. Constipation means retention of faeces 
beyond the usual period, so that they are passed 
with difficulty, and in a comparatively hard state. 
Habitual constipation means a prolonged depart- 
ure from the standard natural to the individual. 
The direct cause may be want of sensibility of 
the nerves of the mucous membrane, so that con- 
tact of food does not cause sufficient stimulus to 
produce muscular action, or want of tone in the 
muscles, or absence of mucous secretion from the 
bowels which lubricates the passages, or finally, 
absorption of fluid, leaving the fasces too solid 
for the muscles to act on. 

Constipation is one of the most common ail- 
ments, and is usually due to faulty dietary and 
sedentary habits, though some persons have a 
marked constitutional tendency to constipation, 
which may be relieved, but cannot always be 
overcome. Almost ail acute diseases occasion- 
ally begin with constipation ; it is also a frequent 



410 Dr. J. Kearts Lectures. 

accompaniment of chronic diseases, pregnancy, 
and various forms of indigestion and affections 
of the liver, as well as from astringent food or 
medicines. There may be constipation although 
stools occur at the ordinary intervals, from a por- 
tion only of each stool passing, another portion 
being retained and gradually accumulating in 
the lower bowel. 

Constipation gives rise to various uneasy and 
often distressing sensations both in the bowels 
and other parts. There is a sense of mental and 
bodily depression, headache, loss of appetite, low 
spirits, often a tendency to vomit; in habitual 
constipation there is also dry skin, a sallow com- 
plexion, scanty urine and low spirits, at times 
amounting to hypochondriasis. The pressure of 
the loaded bowel on the great veins causes cold 
feet by preventing the return of blood from the 
limbs; pressure on the nerves causes numbness 
of the limbs, and on the small veins causes blind 
and bleeding piles. Sometimes chronic inflam- 
mation of the mucous lining of the bowels is the 
cause ; hence, people who lead a luxurious life 
often suffer from habitual constipation. 

Treatment. — Many sufferers from constipa- 
tion are led into the pernicious habit of continual 
use of strong purgatives. The first time he prob- 
ably feels dull, heavy, unable to work and de- 
pressed in spirits, but after the purgative has 
wrought he feels light, elastic, cheerful, and 



Constipation and Gostiveness. 411 

altogether a new man ; encouraged by this result, 
he repeats the dose with less effect each succeed- 
ing time, till finally it positively induces con- 
stipation by causing chronic inflammation of the 
lining membrane of the bowels, and the last state 
is worse than the first. Different persons vary so 
much in the amount of purgatives they require 
that each person must be a law to himself. 

For occasional and accidental constipation any 
of the milder laxatives may be used : tincture of 
lobelia 20 drops in cold water 1 pint as an injec- 
tion, wine of colchicum, castor oil and senna 
being common and safe laxatives. In obstinate 
constipation a drachm of sulphate of magnesia, 
or tincture of cinchona, or tincture of nux vomica 
in a tumbler of water every hour. If there are 
piles, a teaspoonful of sulphur and half a tea- 
spoonful of cream of tartar mixed with honey or 
crystal drips. If the stools are clay-colored, 1 
grain of leptandrin with % drachm of the fluid 
extract of taraxacum. In habitual constipation 
it is important to use drugs as little as possible, 
but take a tablespoonful of white mustard seeds 
in water, swallowed whole, thrice daily. 

A regular habit as to time, moderate outdoor 
exercise, such as horseback riding, hunting, row- 
ing, etc., an hour at least every day. 

Where the mucus secreted is deficient, a glass 
of water before going to bed or just after rising. 
Meals should be taken regularly at the same 



412 Dr. J. Keari's Lectures. 

time, animal food should be taken sparingly. 
There is such a thing as a laxative diet, and it 
should be adhered to by the patient; vegetable 
food, especially succulent vegetables, is more 
laxative than animal, while all oily and fatty 
foods are decidedly laxative, so much so that a 
quarter of a pound of fresh butter melted and 
mixed with 1 oz. of flour acts almost as certainly 
as castor oil. The different breadstuffs seem to 
be laxative in proportion to the amount of fat 
they contain. 

Rice contains very little oil, and hence its con- 
stipating tendency. Corn, on the other hand, is 
very rich and fat, and might be more extensively 
used with advantage, the corn cakes and green 
corn being delicacies of great value in softening 
the bowels. A moderate quantity of liquid 
should be taken with each meal, as very dry food 
favors constipation. 

WORMS. 

Most, if not all, animals and vegetables have 
their own peculiar parasites, animal or vegetable, 
or both. It seems an offense against the economy 
of nature when we see the higher animals, and 
even man himself, perishing to afford food and 
means of propagation to these lower organisms 
which serve no useful purpose and are always 
destructive ; even parasites themselves are infested 



Worms. 413 

with other parasites, a truth expressed in the 
rhyme : 

Big fleas have little fleas upon their backs to bite 'em, 
And little fleas have lesser fleas, so on ad infinitum. 

There are six principal varieties of worms 
which may be found in the bowels: 

Bound worm (Ascaris lumbricoides) is somewhat 
like a large earth-worm, and infests the small 
bowel and gall duct. 

Tape-worms. — They undergo an intermediate 
form of development, comparable to the grub 
state in a moth. The eggs are swallowed by some 
animal and develop a living embryo, after some 
minor changes termed a cysticercus, which be- 
comes encysted in the muscles, and when this is 
taken raw or insufficiently cooked the embryo 
develops into a tape-worm, of which there are 
three chief varieties : Broad tape-worm (Bothrio- 
cephalus latus), found in Russia, Sweden, and 
Switzerland, the embryo of which is taken in 
drinking water, or in eating various fish, such as 
salmon, etc. Common tape-worm (Tamia solium), 
the embryo of which is the cause of so-called 
measles in pigs. The head has four suckers and 
two rows of hooklets. Hookless flat-headed tape- 
worm, the embryo of which is found in calves 
and oxen. The broad tape-worm may be many 
feet in length, and the other two may be found a 
much greater length. They are all narrow at the 
neck, and gradually grow broader as they go 



414 Dr. J. Kean's Lectures. 

down. The growth takes place by Dew joints 
forming at the head ; hence the minute head must 
come away, or there will be no cure. 

Thread-worms, which infest the large bowel. 
The long thread-worm (Tricocephalus dispar), one 
and a half to two inches long, as thin as a hair at 
one end and considerably thicker at the other, 
usually presents no symptoms, but may cause 
diarrhoea. The common, or short thread-worm 
(Oxyuris vermicularis), a quarter to half an inch 
long, is very common in children, and may be 
passed in great numbers in the form of balls. 
The eggs are supposed to be swallowed in bad 
flour and imperfectly washed vegetables. 

Symptoms. — The symptoms vary greatly with 
the peculiarities of the person affected, but gen- 
erally there is marked derangement of general 
health ; the abdomen becomes swollen, hot and 
tense, the appetite variable, often voracious, the 
breath becomes offensive, there are pains in the 
stomach and bowels, itching of the nose causing 
picking, and if a round worm reaches the stom- 
ach, vomiting may be added, by which it is fre- 
quently expelled. In addition to these symptoms, 
there is often considerable wasting, disturbed 
sleep, and grinding of the teeth; pains in the 
limbs, and great depression. In children and 
young people, the irritation of the bowel has 
even caused chorea or epilepsy. Thread-worms 
generally cause intolerable itching of the rectum, 



Hemorrhoids. 415 

irritation and picking of the nose, capricious ap- 
petite, and the worms may be seen moving in 
the stools, which is the conclusive symptom in all 
worm affections. 

Treatment. — There are many good remedies. 
I will give my readers those which are superior 
to all others, yet they should be used with judg- 
ment and caution and varied according to the case : 
Pomegranate-root bark decoction, santonin, cusso 
powders, spirits of turpentine, ethereal extract 
of male fern. I have found, however, the latter 
in my practice to be preferable to all others, given 
as follows : 

Take 

Ethereal extract of male fern % oz. 

Mucilage of acacia 1 oz. 

Mix. 

Dose — The whole at bedtime on a day's fast, 
followed next morning by a brisk cathartic. 

HEMORRHOIDS. 

(Piles.) 
This troublesome affection consists of small tu- 
mors, usually about the size of a grain of corn, 
and which originate from enlargement of the 
ends of the veins in the lower part of the bowel. 
They may be external, around the orifice, either 
one or a cluster, covered with skin, or in- 
ternal near the termination of the bowel, 
and covered with mucous membrane, appear- 
ing of a dark pink or purple color, and vary- 



416 



Dr. J. Kean's Lectures. 



ing in size from that of a pea to a walnut. Piles 
are divided into bleeding piles, which have thin 
walls and bleed from the slightest cause, and 




Fig. 45. — Hemorrhoids. 



blind piles, which do not bleed, the walls be- 
ing thicker, but are more liable to inflammation. 
External piles if indolent appear like folds of 
skin round the orifice and are troublesome only 



Hemorrhoids. 417 

by their bulk, but it inflamed, they become exceed- 
ingly sensitive, tense and painful, appearing like 
a grape in size, and of a purple color, with heat, 
throbbing, straining, and perhaps backache. 
The patient can scarcely sit [see Fig. 45], walk or 
lie, and the passage of even small stools causes 
great pain, which only slowly disappears. If 
the inflamed piles suppurate and burst there is 
immediate relief of all the symptoms. The indi- 
cations of internal piles are very slight at first ; 
there is feeling as if there was a foreign 
body in the bowel requiring to be passed; but 
there is positive pain only when there is a hard 
stool ; usually small amounts of blood and mucus 
are passed at intervals, and there is a continuous 
sense of weight and discomfort, increasing when 
there is inflammation Lo the symptoms already 
mentioned in external hemorrhoids. At first 
the piles are protruded only during straining, and 
if not promptly replaced are grasped by the con- 
stricting muscle of the bowel and more or less 
strangulated, causing great pain and disturbance, 
but after long continuance the hemorrhoids are 
always protruding except when the patient is 
lying down, the constricting muscle becoming 
relaxed. After some time, if the piles bleed 
easily, the patient becomes sallow, loses flesh, 
and presents a bloodless appearance. 

Hemorrhoids may be caused by anything 
which lowers the tone of the veins. In many 

.27 



418 Dr. J. Kean's Lectures. 

people there is an hereditary tendency to piles, 
just as there is to varicose veins. The usual pre- 
disposing causes are sedentary habits, the insuf- 
ficient exercise lowering the tone of the system 
generally, the veins included; luxurious living, 
the excess of food and drink producing conges- 
tion of the liver and preventing the flow of 
blood from the lower veins. Direct causes are 
constipation, pregnancy, and various tumors 
which press on the veins and impede the return 
of blood, the increased pressure causing piles. 
Probably the most frequent of all causes is local 
inflammation of mucous membrane of the bowel, 
weakening the veins and so leading to hemor- 
rhoids; this not unfrequently results from the 
abuse of strong purgative medicines, especially 
aloes, and is often caused by prolonged exposure 
to cold, as from sitting on cold seats. 

Treatment. — For the permanent cure of both 
internal and external piles when of any extent, 
surgical interference is usually required, in 
choosing which be governed by advice on the 
foregoing pages. The treatment consists in pro- 
curing regular daily evacuations of the bowels, 
avoiding strong irritant purgatives. A teaspoon- 
ful of the following mixture twice a day- or 
oftener is a good laxative : half an ounce each of 
sulphur and cream of tartar, and two and a half 
ounces each of lump sugar and syrup of orange 
peel. Careful injection of tincture of lobelia 20 



Affections of the Liver. 419 

drops, and two ounces of cold water before each 
stool, but care must be taken not to injure the 
piles. The cause if possible should be removed ; 
epicureans must restrict themselves to a moderate 
allowance of plain food and sparing use of 
alcohol. 

AFFECTIONS OF THE JjTSTER. 

The liver is composed of cells arranged in 
small groups or lobules, and receives the veins 
from the bowels, termed the portal veins, which 
run along with the artery and bile or hepatic ducts. 
Each lobule has a small branch of the portal 
vein, bringing blood containing matters from the 
digestive organs, from which it secretes the bile, 
which is then received by the branch of the 
hepatic duct and carried to the gall-bladder; the 
purified blood is then received by a small branch 
of the hepatic vein of the liver which begins in 
the middle of the lobule, and is carried to 
the large vein of the lower half of the body, by 
which it enters the general circulation. Thus the 
liver, besides secreting bile, removes any noxious 
matter which may have been taken up from the 
bowels by the blood vessels. 

The liver is subject to a great number of differ- 
ent affections, the symptoms of which are usually 
obscure. The following are merely mentioned, 
as further minuteness would carry me beyond the 
design of this work. 



420 Dr. J. Keari's Lectures. 

ABSCESS 

Is most generally found in tropical climates, 
especially after attacks of dysentery. It may 
open into the lungs, bowels, or externally by sev- 
eral small openings. 

Treatment. — Opening by a surgeon of reputed 
skill, who is a graduate of some recognized col- 
lege of medicine and surgery ; rest, and attention 
to general health. 

ACUTE YELLOW ATROPHY 

Usually commences like a bilious attack, and is 
rapidly followed by jaundice, fever, vomiting, and 
delirium, with high temperature, gradually fall- 
ing into profound sleep, and death occurring in 
the first week. 

CIRRHOSIS. 

The liver is first enlarged, but subsequently 
wastes, and is rough on the surface. The symp- 
toms are usually indigestion, flatulence, and 
wasting; after some time dropsy of the abdomen 
or feet, dirty-yellow skin, and bleeding from the 
bowels or piles. 

Finally, after months or years, the patient dies 
exhausted. The cause is generally spirit-drinking, 
though frequent attacks of intermittent fever and 
immoderate indulgence in hot spices also pro- 
duce it. 



Affections of the Liver. 421 

WAXY LIVER 
Is a degeneration which may occur after long 
continuance of wasting diseases, such as ulcera- 
tions of hones, consumption, malarious fever, 
etc. The liver is never affected alone, hut gener- 
ally along with the spleen and kidney, and in the 
latter stages with the bowels, causing diarrhoea. 
Death occurs from exhaustion. 

FATTY LIVER 
(Infiltration) 
May be either fat stored up in the liver from too 
much food and too little exercise, most commonly 
found in inebriates, or it may be fatty degenera- 
tion seen in poisoning by phosphorus. 

CANCER OF THE LIVER 
Is a common disease and occurs in parts of the 
liver only, usually forming tumors. The patient 
wastes and usually dies of dropsy. 

TUBERCLE OF THE LIVER 

Is an accompaniment of consumption of the 
lungs. 

CONGESTION OF THE LIVER 

May be due to obstructed circulation from dis- 
ease of the heart or lungs (passive), or to in- 
creased secretion of bile, sudden chills, cold 
stages of malarious fevers, over-indulgence in 
food and alcoholic drinks, or exposure to very 



422 Dr. J. Rearms Lectures. 

high temperature. Congestion is frequent. The 
liver is swollen and tender on pressure, and feels 
uneasy on standing. There is usually purging 
of bilious stools, with scalding and slight sick> 
ness, a bitter taste and foul tongue, occasionally 
vomiting and headache. The face is sallow or 
dusky, fat and flabby, and appearing softer than 
healthy flesh. 

Treatment. — Eestricted diet, avoidance of hot 
spices and fermented liquors ; active exercise in 
the open air. Apply vigorously from twenty to 
thirty minutes, over the liver, the following : 

Take 

Olive oil 2 oz. 

Spirits of turpentine J^ oz. 

Mix. 

Take powdered leptandrin, 1 grain, night and 
morning. 

JAUNDICE 

Is a symptom of disease rather than a disease in 
itself. The causes of jaundice are very numerous. 
When from, Suppression, those of the bile prin- 
ciples which are formed in the blood are not ex- 
creted, and accumulating cause jaundice. This 
may be due to deranged circulation in the liver, 
such as congestion. It may be due to various 
acute diseases, such as yellow fever, to animal 
or other poisons, which destroy the red corpus- 
cles of the blood. We see a local example of 
this in a bruise, which becomes green and yellow 



Congestion of the Liver. 423 

before disappeariDg, owing to the destruction ot 
the blood effused under the skin. And finally, it 
may be due to destruction of the secreting liver 
cells, which occur in diseases such as atrophy, 
cancer, tubercle, etc. 

In Obstruction, the bile is reabsorbed after 
being secreted. The gall duct may be choked 
by gall-stones, or foreign bodies from the bowel; 
by inflammation of the lining membrane of the 
bowel choking the orifice; by inflammation of 
the liver or gall duct, by stricture of the duct, 
spasmodic or permanent, or by pressure. In 
jaundice from destruction, after a time there is 
also suppression, the pressure of bile in the gall 
bladder preventing secretion. The color of the 
jaundice is deeper than from suppression only, 
owing to the bile acids which are formed by the 
liver being absorbed, and destroying some of the 
red blood corpuscles. 

The first symptoms noticed, apart from those 
of any disease which may be causing it, is a yel- 
low tint of the white of the eyes and at the roots 
of the nails, gradually appearing also on the 
skin, and most intense on the forehead. The tint 
varies from a very slight yellow, and is invisible 
by gaslight. Pressure on the lips or gums will 
make them become yellow. The urine assumes 
a dark color or deep red, and either it or the per- 
spiration will stain linen yellow. The stools are 
often abundant, and of a white or clay color from 



424 Dr. J. Keari's Lectures. 

absence of bile, and contain more fat than healthy 
stools. There is a bitter taste in the mouth, fatty 
foods will not digest, causing flatulence, owing 
to the absence of bile, which is a strong natural 
antiseptic, and which prepares fat for absorption 
by liquefying it. For the same reason there is 
often considerable wasting. The pulse is slow 
and the patient is languid, sleepy, and very easily 
fatigued. Bleeding sometimes occurs from the 
bowels, gums, or under the skin, from destruction 
of the red blood corpuscles, as in yellow fever 
and scurvy. The skin is dry, scaly, and itching, 
and occasionally there is yellow vision from the 
clear parts of the eye containing bile principles. 
In severe cases there may be drowsiness leading 
to stupor from action of the bile principles on 
the brain. 

To distinguish obstruction from suppression, 
fill about an inch of a test-tube or narrow glass 
with the urine and add a piece of loaf sugar the 
size of a pea ; then add the urine and pour half its 
bulk of strong sulphuric acid gently down the side 
of the tube or glass, so as not to mix the fluids. 
If a purple or scarlet line appears at the junction 
of the liquids it shows bile acids are present, and 
jaundice is therefore clue to obstruction ; but if 
merely a brown color appears, acids are absent, 
and therefore it is due to suppression. 

Treatment. — Remove the cause if possible. 
Food should be meat and soup, no fats. 



Gall Stones. 425 

Take 

Tincture of lobelia 1 oz. 

Tincture of aloes 1% oz. 

Fluid extract of belladonna 20 drops. 

Elixir of taraxacum 4 oz. 

Mix. 

Dose — One teaspoonful thrice daily between 

meals. (See precautionary rules, Lecture XVII.) 

Recovery is shown by the color returning to 

the stools, and gradually fading from the body. 

GALL STONES 
Are usually composed of solidified cholesterin, 
a fatty constituent of bile, and may be nu- 
merous or only one, varying in size from a 
millet seed to a peach. They occur more fre- 
quently in women than in men, and usually 
after middle age, forty to sixty. They are 
very frequent in patients suffering from can- 
cer of the stomach and liver, but their form- 
ation and presence cause no pain till from 
some cause a stone enters the gall duct, when 
the patient is suddenly attacked with violent 
piercing or griping insupportable pain at the 
opening of the duct into the bowel, but soon 
spreading over the abdomen, the right side of the 
chest, and even the right shoulder, and darts 
through the back, in paroxysms varying from a 
few minutes to a few hours in length. There is 
often chills, sickness and vomiting, with consti- 
pation and flatulence. The pain is so violent 



426 Dr. J. Kean's Lectures. 

that patients roll about, moan, and double them- 
selves up. The pulse is small, the skin cold, and 
the face pale and distorted. The passage from 
great agony to complete ease at times occurs sud- 
denly when the stone enters the bowel, but at 
other times the pain subsides gradually. The to- 
tal duration of the attack may be a few hours to 
several days or even weeks. Jaundice is not such 
a frequent symptom as we should expect ; a more 
formidable occurrence is ulceration and perfora- 
tion of the gall bladder and duct. 

Treatment. — Apply turpentine and oil, usual 
strength. Take alkaline drinks, such as bicarbo- 
nate of soda or potash. All drinks, baths [see 
Alkaline Spring, Lecture XVI], fomentations, 
etc., should be applied hot, followed by a gentle 
cathartic. 

DISEASES OF THE ABDOME3ST. 

The abdomen is lined inside by a thin, 
shining, serous membrane, called the perito- 
neum, in a complicated fold of which are 
enclosed the bowels with their blood ves- 
sels, digestive vessels, or lacteals and glands. 
There are three principal diseases in connection 
with this membrane : Inflammation (peritonitis), 
dropsy (ascites), and diseases of the digestive 
glands enclosed in the fold (consumption of the 
bowels). 



Peritonitis. 427 

PERITONITIS 

(Inflammation) 
May be acute or chronic, and of a part or of the 
whole. It may occur from wounds or ulcers open- 
ing into the lining membrane, from extension of 
other inflammation of parts near it, or occasion- 
ally from cold in rheumatic persons. 

Acute Peritonitis, usually from perforation of 
an ulcer, begins by sudden severe pain at one 
spot ; but soon the whole abdomen becomes very 
painful, and the pain is greatly increased by the 
slightest pressure or movement; even the weight 
of the bedclothes may become unbearable: the 
abdomen becomes hard, hot, and swollen from 
inflammation of the outside serous lining of the 
bowels (peritoneum) paralyzing the muscular 
coat and allowing the gut to become distended 
with air either from the decomposing contents of 
the bowel or from the blood ; the skin is dry and 
burning. The patient does not toss about as in 
colic, but lies on the back with the knees bent and 
drawn up to relax the muscles. There is quick, 
feeble pulse (90 to 120), anxious face, foul tongue, 
frequent vomiting and constipation; the patient 
fears to cough or speak loud, and takes slight 
breaths with the chest only ; hence the breathing 
is very rapid (40 to 60 breaths in a minute). 
After a time the abdomen becomes more dis- 
tended, partly by fluid in its cavity and partly by 
air in the bowels, and when the disease is about 




Pig. 46.— Peritonitis. 



Ascites, 429 

to end fatally it becomes swollen like a drum; 
the face is a ghastly visage and the body covered 
with cold clammy perspiration. Death usually 
takes place from exhaustion within the first eight 
or ten days. [See Fig. 46.] 

If the disease takes a favorable course, the 
pain, swelling, and fever subside, and the patient 
recovers rapidly ; but frequently adhesions of the 
bowels are left, causing occasional pain and con- 
stipation for the remainder of life. 

Treatment. — Morphia one-sixth grain every 
hour till its eflects are seen, repeated thereafter 
every third hour. The bowels must be prevented 
from moving for several days ; turpentine cloths 
over the abdomen ; ice to relieve the thirst and 
vomiting; liquid food — milk and beef-tea are 
best; if vomited, injections of milk and beef-tea. 

Chronic Peritonitis may follow acute, but more 
frequently is chronic from the beginning, especi- 
ally in scrofulous children. There is slight pain 
and tenderness on pressure, wasting and slight 
fever, alternate constipation and diarrhoea, with 
swollen abdomen. 

Treatment. — Milk diet; iodide of potassium 
4 grains daily. 

ASCITES. 
(Dropsy of the Abdomen.) 

The lining membrane of the abdomen secretes 
a small amount of fluid in health, which allows 
the opposing surfaces to glide smoothly over 



430 Dr. J. Keari's Lectures. 

each other. Dropsy may be due to anything 
which either increases the secretion of this fluid, 
or more commonly which prevents its absorption, 
the secretion still going on. The cause may be 
disease of the liver, heart, kidneys, or chronic 
peritonitis. The abdomen becomes swollen with 
enlarged blue veins running over it. When lying 
down the shape changes with every movement ; 
the uppermost part sounds hollow on percussion 
from the bowels floating to the top of the fluid ; 
but on changing the position the part now upper- 
most sounds hollow, while the former part sounds 
dull, the navel is protruded, and there is also 
occasionally dropsy of the nether limbs. The 
upper part of the body is wasted, breathing is 
interfered with, especially when lying down, the 
urine is scanty, the skin dry, and the patient suf- 
fers from thirst, loss of appetite, low spirits and 
weakness. 

Treatment must be varied according to the 
supposed cause. 
Take 

Tartrate of iron % oz. 

Bitartrate of potassium 1 oz. 

Mix. 

Make nine powders. 

Dose — One three times a day before meals. 
Take 

Tincture of digitalis 75 drops. 

Camphor water 1 pint. 

Mix 



Consumption of the Bowels. 481 

Dose — Half wineglassful thrice daily, to be 
taken on alternate days. 

Take 

Powdered podophyllum 50 grains. 

•Powdered leptandrin 10 grains. 

Mix. 

Make ten powders. 

Dose — One every night. Repeat every evening 
if necessary to keep the bowels regular. (See pre- 
caution ary rules, Lecture XVII.) 

TABES-MESENTERICA 
(Consumption of the Bowels) 
Is a local indication of a general disease " scrof- 
ula," which attacks the glands of the digestive 
vessels, or lacteals, and destroys them by slow 
inflammation as it does the glands of the neck, 
or by deposition of a peculiar matter called tu- 
bercle, which softens and breaks down, causing 
abscess or ulceration. Tubercle may attack any 
part of the body except the muscles, blood-ves- 
sels, and cartilage; but the parts most liable are, 
in infancy, the head, causing water-on-the-brain 
fever (tubercular meningitis); in childhood, the 
abdomen, causing consumption of the bowels; 
and after puberty, the lungs, causing ordinary 
consumption; when it appears in other places, it 
is usually secondary to the foregoing, and it is 
worthy of remark that it is never found at birth. 
The symptoms are hard swollen abdomen, 
more or less constant pain in the bowels, with 



432 Dr. J. Kearts Lectures. 

unhealthy, watery, offensive stools, and occa- 
sional constipation; the body wastes, the face 
becomes pale, and there is rapidly increasing 
weakness. 

Treatment. — Milk diet, varied occasionally 
by adding a little lime or soda water. 

Take 

Phosphate of iron .% oz. 

Iodide of potash 1 scruple. 

Mix. 

Make 20 powders. 

Dose — Take one three times a day. 

Flannel to be worn next the skin both night 
and day, free ventilation, tepid baths (see Treat- 
ment of Scrofula and Consumption). 



LECTURE XL 



Diseases of the Urinary System— (N. B. Venereal dis- 
eases are given in Lectures published separately.)— Uri- 
nary Sediments, or Gravel. — Uric or Lithic, Phospha- 
tic and Oxalic Diatheses. — Stone in the Kidney. — 
Bright's Disease. — Inflammation of the Kidney.— Hem- 
aturia, or Blood in the Urine. — Suppression, Retention 
and Incontinence of Urine.— Inflammation of the Blad- 
der.— Stone in the Bladder.— The Urine. 



DISEASES OF THE URINARY 
SYSTEM. 

N. B. — Venereal Diseases are given in Green 
Book Lectures, published separately. 

GRAVEL 

CONSISTS of cod crete particles of the urinary 
sediments, which, when larger, form stone in 
the bladder or kidney. There is not unfre- 
quently hereditary tendency to its formation, and 
that to the same form of gravel as the parents. 

There are three kinds of gravel, each of which 
may be caused by a constitutional tendency to its 
formation (diathesis). 

Uric, or Lithic Acid Diathesis. — When urates 
are excreted in such excess that they are de- 
posited in the chamber vessel when the urine 
cools, appearing like brick-dust in color. If the 

28 



484 Dr. J. Kean's Lectures. 

particles are of any size there is pain shooting 
from the kidney to the bladder, when passing 
water, there are instances also of sickness. The 
cause is usually errors in diet and sedentary habits, 
strong wines, malt liquors, and too much animal 
food, and anything which causes indigestion. It 
also occurs in gout and rheumatism, and towards 
the end of fevers and acute inflammations. The 
urine is acid, sp. gr. 1015 to 1035, and the deposit 
redissolves on the application of heat. 

TREATMENT. 

Take 

Fluid extract of barosma crenata 2 oz. 

Oil of juniper berries 10 drops. 

Mucilage of acacia 1 pint. 

Mix. 

Dose — Two tablespoonfuls three times a day. 

Take 

Bicarbonate of potash 2 oz. 

Water 1 pint. 

Mix. 

Dose — Wineglassful every four hours. 
In connection with the above, take a compound 
podophyllin pill, if necessary, to keep the bowels 
regular. (See precautionary rules, Lecture XVII.) 
The patient must regulate his own diet, avoid- 
ing anything which disorders the stomach. He 
should rise early, take a good deal of exercise, 
and be warmly clad. 

Phosphatic diathesis. — When the phosphates are 
excreted in excess the urine on standing deposits 



Grovel. 435 

a white material like very fine white sand, and 
may have an iridescent film of phosphates, or it 
may be of a slight milky color when passed. 
The deposit is not dissolved by heat, but readily 
disappears by adding a little nijtric acid. The 
cause of this variety may be anything which 
weakens the system — a naturally weak system, 
severe mental exertion, exposure to cold — and 
one form, the triple phosphate, often proceeds 
from irritation or inflammation of the bladder. 

Treatment. — Tonics and acids with warmth 
and good diet. 

Take 

Muriate tincture of iron 15 drops 

in a half tumbler of water thrice daily; alter- 
nating every second day with syrup of hydrangea 
one teaspoonful three times daily. 

Oxalic acid diathesis. — The urine is generally 
clear, pale, and contains a small cloud of pale 
mucus entangling crystals of oxalate of lime. 
The symptoms are transient pain on making 
water from irritation of the passages by the 
crystals. 

The causes may be constitutional or from eat- 
ing vegetables containing oxalates, especially 
rhubarb and sorrel; sparkling wines have like 
effect. 

Treatment. — 10 drops of dilute nitro-hydro- 
chloric acid in a glass of water three times a 
day, cold bathing, warm clothing, and friction of 
the skin. 



436 Dr. J . Keari's Lectures. 

COLICA KEPHKITICA. 
(Stone in the Kidney.) 
Any of the variety of salts before mentioned 
may form a concrete mass or stone either in the 
kidney or in the bladder. So long as the stone is 
retained in the kidney it may give rise to no un- 
easiness, but if of considerable size it may cause 
almost constant backache, bloody urine, especi- 
ally after exertion, nervous irritability with loss 
of strength and wasting. 

When the stone passes into the urinal duct 
leading to the bladder it sets up violent symptoms. 
There is sudden excruciating agony in the loins, 
with irritation of the bladder, and often with 
sickness and vomiting, but notwithstanding this 
the quickness of the pulse and heat of the skin 
and body are unaffected. After a time the par- 
oxysm of pain remits, and the patient has a short 
interval of ease ; but it soon returns, till, after 
several paroxysms, the stone passes into the blad- 
der, giving instant relief to the acute pain, but 
leaving a sense of soreness for some time. 

Treatment. — During the attack a hot bath, 
and apply turpentine over the aflected part. 

Take 

Fluid extract polygonum hydropip- 

eroides 1 oz. 

Fluid extract uva ursa 2 oz. 

Syrup of orange peel 3 oz. 

Mix. 

Dose — One teaspoonful thrice daily. 



BrighVs Disease of the Kidney. 437 

Take 

Bicarbonate of potash 1 oz. 

Water 4 oz. 

Mix. 

Dose — Tablespoonful night and morning in 
conjunction with the above (see precautionary 
rules, Lecture XVII). 

Warm mucilaginous drink to be used, but 
avoid saccharine and oleaginous matters — sugar, 
starch and fat. 

BRIGHT'S DISEASE OF THE KIDNEY. 

The substance of the kidneys is composed essen- 
tially of a number of long tubes lined by secret- 
ing cells, of blood-vessels, and of some connective 
tissue or packing material. A urinary tube 
usually commences near the surface of the kid- 
neys as a dilated sac (Malpighian body) enclosing 
a tuft of blood-vessels, forming the sudden termi- 
nation of an artery and vein, the small branches 
dividing so quickly from the main vessel as to 
resemble a rubber headed pencil. This tuft 
allows the water of the urine to pass through the 
walls of the vessels composing it, from the blood 
into the urinary tube. The vein which issues 
from the tuft in which the artery terminates 
passes to the urinary tube below the sac, and 
breaks up into a fine network surrounding 
the tube, and finally reunites to pass off to 
the great vein of the kidney. It is from the 
less watery blood in this venous network that 



438 Dr. J. Kean's Lectures. 

the solid constituents of the urine are drawn 
into the cavity of the urinary tube through the 
agency of the secreting cells with which it is 
lined. These solids are washed away by the 
stream of water from the tuft in the sac at the 
end of the tube. The urinary tubes which are 
convoluted in their glandular or secreting portion 
pass straight or simply looped to the inner edge 
of the kidney, where they open on little projec- 
tions, or papillae, which are contained in several 
cup-shaped depressions in the expanded end 
(pelvis) of the duct to the bladder or ureter. 

Bright's disease, usually associated with albu- 
men in the urine, dropsy, and various secondary 
diseases, is of three different kinds : 

1. Inflammatory, affecting the urinary tubes. 

2. Waxy, affecting the blood-vessels. 

3. Cirrhotic, affecting the connective tissue; 
but there may be a mixture of any two kinds. 

Inflammatory, or acute Bright's disease, has 
three stages — 1st. Inflammation of the cells lining 
the urinary tubes ; 2d. Fatty degeneration of the 
cells, which are washed out as tube casts; 3d. 
Wasting of the kidney. 

After exposure to cold, wet, intemperance, or 
some acute disease, especially scarlet fever, an 
individual has pain in the loins, frequent calls to 
pass urine, but makes little at a time, and that 
little of a dark smoky color. The face and 
nether limbs swell, at first below the eyes and the 



Bright 1 * Disease of the Kidney. 43 ( J 

ankles ; breathing may be difficult, and there is 
moie or less fever, with perhaps headache and 
drowsiness. When the disease is about to end 
fatally, the urine, and its dissolved solid contents 
especially, decrease from the destruction of the 
secreting cells and blocking up of the urinary 
tubes. When much of the kidney is involved, 
death may take place within two weeks. The 
urine deposits a sediment of blood, fatty or hyalin 
tube casts, and may all become solid when 
heated, from the amount of albumen it contains. 
When recovery is about to take place, the urine 
increases enormously, the albumen decreasing 
and finally disappearing. 

Treatment. — During the acute stage apply 
poultices and dry cupping to the back. 

Take 

Fluid extract digitalis % oz - 

Acetate of potash 1 oz. 

Water 4 oz. 

Mix. 

Dose — One teaspoonful three times a day. 

Take 

Bitartrate of potash % oz - 

New milk 4 oz. 

Mix. 

At one dose every morning in connection with 
above, and take tincture of iron 15 drops thrice 
daily every third day, in connection with an 
occasional hot bath ; wear flannel next the skin ; 
subsist on farinaceous diet. 



440 Dr. J. Kean's Lectures. 

Waxy is usually part of a general waxy degen- 
eration in sufferers from wasting diseases, such as 
death or ulceration of bone, causing long-con- 
tinued suppuration, scrofula, etc. The patient 
feels increasing weakness, and begins to pass 
large quantities of pale-colored urine, having to 
rise several times during the night. The ankles 
and below the eyelids become swollen. The pro- 
portion of albumen is at first small, but gradually 
increases. Shortness of breath and indigestion, 
with loss of appetite, or even loathing of food, 
with dry harsh skin, quick pulse, and increasing 
pallor of the skin, are among the earlier symp- 
toms. Diarrhoea is common in the later stages. 

Treatment. — Warm flannel clothing, and 
avoid exposure ; if bowels are too free, the cholera 
prescription as directed on a previous page, and 
take tincture of iron 15 drops in half tumbler of 
water thrice daily, an hour before meals; repair 
the digestive functions by the following : 

Take 

Pepsine 50 grains. 

Subnitrate of bismuth 10 grains. 

Mix. 

Make ten powders. 

Dose — One before dinner, daily. 

Avoid cold and preparations of mercury (see 
mercury, Lecture XVII). 

Cirrhotic or gouty kidney, is the most hopeless, 
but has the longest continuance of all forms 



3 ephritis. 441 

There is increasing weakness and pallor of the 
skin. Swelling of the ankles and lining mem- 
brane of the eye, a chronic cough, and headache 
at the top of the head, with indigestion, and there 
may be one or more secondary diseases. Con- 
gestion of the lungs, hypertrophy of the heart, 
apoplexy, and disease of the interior of the eye 
(retinitis.) 

Treatment. — Same as next preceding disease. 

NEPHRITIS 

(Inflammation of the Kidney) 

May arise without apparent cause, or from ex- 
posure to cold, injuries, intemperance, irritating 
medicines, etc. The morbid action may cease, 
and health be restored, or it may continue and 
form one or more abscesses. When one kidney 
only is affected the symptoms are felt only on one 
side. There is severe pain in the loins, increased 
by exercise or pressure, the pain often extending 
along the ureter to the neck of the bladder, and 
to the groin, with a feeling of numbness down 
the thigh. There is sickness and vomiting, chills 
and fever; a quick hard palse. The urine is 
passed frequently, and is of a deep-red color, 
rarely pale, and frequently suppressed with con- 
vulsions. The bowels are constipated and sub- 
ject to colicky pains, and finally pus is passed in 
the urine. 



442 Dr. J. Kean's Lectures. 

Treatment. — Rest in bed and — 

Take 

Acetate of morphia . . .5 grains. 

Fluid extract of gelsemiura }£ oz. 

Tincture of aconite . . . . % oz. 

Water 4 oz. 

Mix. 

Dose — One teaspoonful every hour. Apply tur- 
pentine and oil to the kidneys, followed by hot 
fomentation of the following : 

Take 

Muriate of ammonia 1 oz. 

Solid extract of belladonna % oz. 

Boiling water 1 pint. 

Mix. 

Give mucilaginous drinks, new milk and fari- 
naceous diet. (See precautionary rules, Lecture 
XVII.) 

Dropsy of the kidney, in which a stone or 
tumor chokes the ureter, and the kidney finally 
becomes a mere shell. Cancer of, and movable 
kidney often cannot be distinguished during life 
even by good physicians, and will not be further 
dwelt upon here. 

HEMATURIA 

(HAEMORRHAGE PROM THE BLADDER) 

May be from the kidney, bladder, or ducts (ure- 
ter and urethra). The urine is of a smoky, black, 
or port-wine hue, if from the kidneys ; clear, with 
coagulations of blood, if from the bladder. The 



Suppression of Urine. 443 

most common causes are Bright's disease, can- 
cer, stone, or some morbid poison in the blood. 
There is an intermittent form associated with 
malaria, and another form due to the presence 
of a small parasite in the veins of the kidney. 

Treatment. — Tincture of iron, fifteen drops, 
in half an ounce of glycerine, every four hours. 
When due to ague, see my treatment for that 
disease. 

SUPPRESSION OF URINE 

Is a complete or partial suspension of the action 
of the kidneys, by which the urine is greatly di- 
minished, or may be entirely suppressed. There 
may be some pain in the back, or irritability ot 
the bladder, with sickness and hiccough; the 
body exhales a urinous odor, and in most cases, 
sooner or later, symptoms of poisoning by the 
retained urinary principles appear (uraemia). 
Children when teething may pass only a few 
drops of high-colored urine, which stains the 
linen and causes scalding, making the child cry. 
Patients may recover after three to fiYe, and even 
nine days' suppression of urine, and when death 
occurs it is usually by poisoning (uraemia) by the 
retained urinary principles, the symptoms of 
which are headache and vomiting, gradually in- 
creasing drowsiness going on to complete stupor, 
convulsions or fits. The stupor continues getting 
deeper till death occurs. 



444 Dr. J. KearCs Lectures. 

Treatment. — When the suppression depends 
on uraemia only, 

Take 

Bitartrate of potash % drachm 

at each dose night and morning. 

Take 

Fluid extract of barosma crenata 2 oz. 

Fluid extract polygonum hydropiperoides.l oz. 

Acetate of potash 3€ oz * 

Water .3 oz. 

Mix. 

Dose — One teaspoonful, three times a day. 
Use warm drinks, Turkish and hot baths. 

RETENTION OF URINE 
Is when the urine is secreted but retained in the 
bladder, and may be caused by palsy of the mus- 
cular fibres of the bladder from any cause, 
usually from exposure to cold, from spasm of the 
urethra, from hysteria, and from various surgical 
causes, such as stricture, pressure of a tumor or 
abscess, inflammation, or impaction of a stone. 
To distinguish retention from suppression, the 
distended bladder may be felt in the lower part 
of the abdomen when no urine is passed from re- 
tention. 

Treatment. — Large doses of opium adminis- 
tered to cause relaxation of the sphincter muscle 
of the bladder, by a person qualified in the ad- 
ministration of medicine. Hot fomentations over 
the bladder, or insert a catheter. 



Cystitis. 445 

INCONTINENCE OF URINE 

In the aged, may really be retention, the para- 
lyzed bladder becoming tilled, and the excess 
dribbling away constantly as it is formed; in 
middle age may arise from a great variety of 
causes: stone in the bladder, paralysis of the neck 
of the bladder, piles, etc. 

In children who wet their beds it may be due 
to the irritation of worms in the bowel, weakly 
constitution, indigestion etc. 

Treatment. — Good, nutritious diet; new milk, 
warm, if possible, from the cow. 

Take 

Tincture of iron 3^ oz - 

Water 4 oz. 

Mix. 

Dose — One teaspoonful in a half tumbler of. 
water, thrice daily. Half the above dose for chil- 
dren, avoiding salt food and acids. In cases of 
aged people it is often necessary to resort to the 
catheter. Stone or calculus often requires the 
assistance of a skillful surgeon. 

CYSTITIS 

(Inflammation of the Bladder) 
Is a severe disease which may be due to exten- 
sion of some other inflammation, or it may arise 
independently. It may be acute or chronic, sup- 
purating or serous, extending over the whole 
bladder or only a part. In acute, the symptoms 
are chills, pain, and heat, a constant desire to 
pass urine, which escapes in small quantities and 



446 Dr. J. Kean's Lectures. 

with pain, high fever, sickness, and vomiting; in 
severe cases, delirium and exhaustion. When 
pus is formed, it is mixed with the urine which is 
passed. In chronic cases, which are more com- 
mon, and may be due to gout, extension of other 
inflammations, irritating urine, etc., the symp- 
toms are often slight ; there is a feeling of indis- 
position, tenderness of the walls of the bladder, 
which may sometimes be felt as a small, round, 
tender tumor, frequent passing of urine, which is 
scanty and contains pus. 

Treatment. — In acute cases, opium % grain, 
solid extract of belladonna quarter of a grain every 
four hours, till the pain is abated, hot fomenta- 
tions. A tablespoonful of castor oil, broth, lin- 
seed tea, or other mucilaginous drinks ; avoid salt, 
spices and spirits. In chronic cases, fluid extract 
of uva ursi half teaspoonful thrice daily. 

STONE m THE BLADDER 

May consist of uric acid, phosphate of ammonia 
and magnesia, phosphate of lime, oxalate of 
lime, etc. The symptoms are severe attacks of 
pain in the bladder, brought on or aggravated by 
exercise ; frequent passage of urine, with a feeling 
that the bladder is not thoroughly emptied ; the 
stream of urine is often suddenly obstructed by 
the stone being forced against the neck of the 
bladder, but on making any movement it returns. 
Treatment. — The only treatment of any avail 



Urine 447 

is an operation by a surgeon specially skilled in 
urinary difficulties, who is a graduate of medi- 
cine and surgery from some college of good 
standing. 

Bicarbonate of potash half a drachm twice a 
day often gives relief. 

URINE. 

The daily amount of urine passed in health is 
about two and a half pints, slightly acid, of a 
specific gravity of 1018 to 1020. It contains 
about 14 parts in the thousand of urea, 4 uric 
acid, 10 parts of animal matter, and 8 parts salts, 
giving 33 ounces of solid to 1000 ounces of urine. 

The color of urine may vary. A pale urine is 
generally copious; if of a reddish smoky color 
it contains blood ; if a green color it contains bile ; 
bilious urine may be dark green. Albuminous 
urine is always light colored. Diabetic urine is 
of a slight milk hue ; if pale clear, with a cloud of 
mucus at the bottom, having an ill-defined upper 
edge, suspect oxalates. If the density is above 
1030, suspect sugar in the urine (see Diabetes). 

Among the chemical tests the more simple are 
the following : 

For Albumen. — Add a drop of nitric acid to 
about an inch in depth of urine in a test tube ; boil 
it over a spirit lamp. If there is albumen, there 
will be a white precipitate not dissolved by 
nitric acid. 



448 Dr. J. Kean's Lectures. 

Phosphates may give a white precipitate when 
boiled, but it dissolves in nitric acid. 

For Pus. — When caustic potash is added, it 
becomes a thick, stringy mass. 

For Bile. — Place a drop of urine and of strong 
nitric acid on a white porcelain plate, and tilt it 
a little till the liquids join, when there will be a 
brilliant play of colors. 

For Sugar (see Diabetes). 

Under the microscope : In Bright's disease the 
different tube casts, in oxalic acid diathesis the 
crystals of oxalate of lime, and blood or pus cor- 
puscles, etc., serve to confirm the judgment made 
as to the disease. 

The urine may decompose in the bladder, but 
does not putrefy in the ordinary sense, if the 
urethra be healthy. 

In cases of urinary difficulties and many others 
caused by them, it is of the greatest importance 
that each patient should know the result of a 
careful analysis of the urine. 

Such result can be readily given by the author 
merely upon receipt of a portion retained and 
forwarded to him for the purpose here indicated. 



LECTURE XII. 

Diseases of the Skin— (N. B. See Lectures on Venereal 
Diseases, published separately.)— Erythema.— Uticaria 
or Nettle Rash.— Lichen.— Red or White Gum.— Prur- 
igo.— Psoriasis or Lepra.— Ichthyosis.— Herpes or Tet- 
ter.— Shingles.— Pemphigus.— Rupia.— Eczema.— Acne. 
—Corns.— Bunions.— Warts.— Freckles.— Boils.— Chil- 
blains. — Ringworm. — Fawns. — Bald Spots. — Liver 
Spots.— Itch. 

AFFECTIONS OF THE SKIN. 

DISEASES of the skin are often among the 
most dime alt to recognize of all affections. 
Not only does the same .eruption change its 
appearance during its progress, but there may be 
two or more separate affections of the skin at the 
same time. The difficulty should be closely 
examined in the different parts of the body 
where it presents itself, especially where it is just 
commencing. They are divided into non-infec- 
tious and infectious, the latter about one to four 
of the former. 

It is difficult to get the fungus of the different 
parasitic skin diseases to grow, but it is equally 
difficult to extirpate when taken root. 

29 



450 Dr. J. K earl's Lectures. 

NON-INFECTIOUS DISEASES, 
ERYTHEMA 
(Simple Redness) 
Consists of distinct patches of some size of a uni- 
form redness with puffiness of the anected skin, 
accompanied by little or no constitutional dis- 
turbance. There are several varieties ; the most 
common form of all consists of red oval patches 
elevated above the skin, appearing generally on 
the front of the nether limbs and arms, with the 
long diameter in the direction of the limb, and 
forming excrescences about an inch broad and an 
inch and a half in length. This variety is called 
Nodosum, and is most common in young women 
and feeble boys, and accompanied by slight fever. 
After a few days the rose-red of the patches 
changes to a bluish color, and the patches soften 
and gradually disappear. 

TKEATMENT. 

Take 

Quinine 2 grains. 

Carbonate of iron 4 grains. 

Mix. 

Make three powders. 

Dose — One powder thrice daily. Apply mild 
zinc ointment over patches. 

URTICARIA 

(Nettle Rash) 
Is an eruption of little solid elastic wheals, whit- 
ish in the centre and reddish at the edges, the 



Lichen. 451 

appearance being exactly the same as that pro- 
duced by the stinging of a nettle — hence the 
name. It is attended with intense itching and 
heat, with a burning, tingling, or prickling sen- 
sation, much like that produced by a mosquito. 
It is often closely connected with derangement of 
the stomach, but may also be produced by influ- 
ences acting on the nervous system, such as rheum- 
atism and irritation of the womb. There is often 
fever ; errors in diet are the most common cause, 
some kinds of food scarcely ever fail to produce 
it in certain individuals. The duration varies 
from a few hours to a few days; it is chronic in 
some cases, and in such there may be an heredi- 
tary constitutional tendency to it. 

Treatment. — At the beginning of an attack 
an emetic to empty the stomach of irritating 
matters; give plain food, and apply the following 
to the aflected surface : 
Take 

Muriate of ammonia 1 oz. 

Solid extract of belladonna % oz. 

Boiling water 1 pint. 

Mix. 

Also apply acetic acid dilute to the affected 
parts, and if necessary remedies as in the previous 
disease. 

LICHEN 

Is an eruption of minute red pimples, either dis- 
tinct or arranged in clusters, accompanied by 



452 Dr. J. K earl's Lectures. 

tingling, irritation, and often intense itching. 
When the pimples become excoriated, they give 
vent to a serous fluid which forms crusts. There 
are five varieties : 

1. Simple; where there is slight fever and 
itching or tingling. The eruption fades in about 
a week, and there is slight peeling of the skin. 
This form is apt to return every spring or sum- 
mer in irritable constitutions. 




Fig. 47.— Lichen. 

2. Affecting the roots of the hair, often due to 
stomach derangements, especially from alcohol. 

3. Clustered lichen. Irregularly circular 
patches with well-defined edges. 

4. Severe form, in which there is considerable 
fever, and the pimples are much inflamed [see 
Fig. 47], seated on a hot, red, swollen skin. After 
a short time the inflammation diminishes, the 
skin becomes fissured, and exudes a serous fluid 
forming thin scaly crusts. The itching, tingling, 
and smarting are intense. 

5. Prickly heat. 



Prurigo. 453 

Treatment. — Apply mild zinc ointment to the 
aflected parts, and an alkaline bath every night, 
prepared as follows : 

Take 

Bicarbonate of soda 1 oz. 

Boiling water 2 pints. 

Mix. 

Sponge the body with the lukewarm solution, 
and take a gentle cathartic. (See Alkaline 
Spring, Lecture XVI.) 

RED OR WHITE GUM 
Is a form of lichen (small red pimples) in chil- 
dren, which may appear in any part or extend 
over the whole body, and is due to derangement 
of the stomach from improper feeding, or to irri- 
tation of the gums. 

Treatment. — Careful diet ; see particularly to 
the milk. Half a teaspoonful solution of carbon- 
ate of magnesia. Lance the gums if difficult 
teething is the cause. 

PRURIGO. 

A chronic eruption of small pimples, the tops 
being abrased, yellow or blackish crusts of blood 
and serum are formed, accompanied by intense 
itching and discomfort, often with a sensation of 
creeping of insects over the skin. It attacks the 
scrofulous and weakly by preference, and is gen- 
erally associated with errors in diet. Fissures of 
the skin which bleed and are very painful, are a 
frequent complication usually where the skin is 



454 J)r. J. Hearts Lectures. 

naturally in folds, as at the anus, angles of the 
mouth, joints, etc. The form which occurs in old 
age may continue for the remainder of life. 

Treatment. — Apply mild zinc ointment to the 
affected parts. Take an alkaline bath every 
night, and if necessaiy a gentle cathartic. 

Take 

Iodide of potash % drachm. 

Water 4 oz. 

Mix. 

Dose — Teaspoonful, thrice daily. 
Diet should be new milk, warm, if possible, 
from the cow. 

LEPBA 
(Psoriasis) 
Is a scaly disease, one of the most obstinate of all 
skin diseases, and is usually preceded and accom- 
panied by acid indigestion, a dry skin, feeble cir- 
culation, and a tendency to gout. The eruption 
occurs in irregular red patches, slightly raised 
above the level of the skin, and covered with thin, 
dry, white scales. The patches may be small 
spots, rings, or large patches, most frequently in 
the neighborhood of the joints, especially the el- 
bow and knee, and often accompanied by intense 
itching. 

Treatment. — As there are three different I 
kinds, arising from various causes (all of which 
are described in G. B., published separately), to | 
distinguish one from the other requires a physi- 



Herpes Zoster. 455 

cian skilled in the diagnosis and treatment ot 
this class of cases. 

ICHTHYOSIS 
Is a very rare disease in which there are scales 
like a fish skin, forming a dirty grey coating over 
the backs of the arms and nether limbs, but 
avoiding the hands, feet, bends of the knee and 
elbows. It is due to excessive growth of the 
scarf skin, such as is seen in corns, and is usually 
hereditary, causing no inconvenience. 

Treatment is often unavailing. Apply mild 
zinc ointment, and take an alkaline bath every 
second day. 

HERPES 
(Tetter) 
Consists of clusters of vesicles or minute blisters 
upon inflamed patches of variable size. The 
eruption runs a definite course, rarely lasts more 
than three or four days, except in shingles, is not 
severe, and leaves no scar ; it is frequently seen 
on the upper lip during a cold. The chief form 
is: 

HERPES ZOSTER. 
(Shingles.) 
A belt of skin on one side is felt to be tender 
and painful, but at first nothing is seen; in 
about a day, however, little red points are seen 
arranged in long oval groups on the painful part. 
The following day the red points have become 
covered with clear vesicles of a slight opal tint, 



456 Dr. J. Kearts Lectures. 

situated on a red base. The size of vesicles varies 
from a pin's head to a pea. The eruption occurs 
along the course of a nerve, on one side of the 
body only, usually from the spine to the front of 
the body, forming half a belt, and is attended 
with stinging or burning pain and slight fever. 
It usually continues for about ten days when not 
interfered with, and may occur at any age with- 
out any special derangement of health. 

Treatment. — Apply mild zinc ointment over 
the affected part, or the muriate of ammonia and 
belladonna fomentation, or paint every second 
night with collodion or iodine. (See precaution- 
ary rules, Lecture XVII.) 

PEMPHIGUS. 

Large blebs about the size of a marble occur- 
ring in successive crops, on a slightly reddened 
surface; the fluid contained is transparent or 
slightly yellowish, and after evacuation a thin 
crust remains. It is frequently attended with pain, 
heat, or itching, but often there are no apparent 
symptoms beyond the blebs. One attack may 
remain for two or three weeks, and after a vari- 
able interval a second, third, fourth, and fifth 
may occur, or it may be chronic, a succession of 
blebs following each other till the death of the 
patient. Chronic pemphigus is a very fatal dis- 
ease, the patient dying of exhaustion. It is a 
comparatively rare complaint. 



Pemphigus. 457 

Treatment. — Good diet. 

Take 

Iodide of potash 3€ oz - 

Syrup of stillingia 4 oz. 

Mix. 

Dose — One teaspoonful thrice daily. 

Take 

Tincture of iron J4" oz - 

Water 4 oz. 

Mix. 

Dose — One teaspoonful thrice daily. 
The above must be taken on alternate days. 
RUPIA 
Resembles pemphigus, excepting, however, that 
they are isolated and of longer duration. After 
they burst, a scab is formed, which gradually 
thickens by the addition of fresh exudations from 
ulceration of the skin, the successive layers form- 
ing a dark prominent scab, beneath which is a 
foul ulcer that leaves a scar. It lasts from two to 
three weeks to several months, and occurs in 
weakly constitutions, especially those contami- 
nated with the poison of syphilis. (See G-. B., 
published separately.) It is not common. 

Treatment is according to the cause : if from 
a weakly constitution, quinine, 2 grains ; tincture 
of iron, 20 drops, in a half tumbler of water, 
thrice daily. 

ECZEMA 
Is one of the most common skin diseases, either 
alone or as a complication of others. A portion 



458 Dr. J. KearCs Lectures. 

of skin becomes red, inflamed, and stifi with nu- 
merous minute vesicles, pimples and papules, the 
skin peels off, and a watery exudation, sometimes 
purulent or mixed with blood, oozes out. The 
exudation dries into crusts on the skin. There is 
itching, which is made worse by touching the 
part; at the same time there is an almost irre- 
sistible desire to scratch. The skin has a doughy 
feel, and shows a yellowish hue on pressure. If 
a fold of skin be pinched up it feels thick and 
swollen, and when the disease is fully developed, 
the skin is red, shining, and has little exudations. 
The causes are various: direct irritation of the 
skin from any cause, a common one being ex- 
cessive heat, obstruction of the circulation in the 
veins, and an hereditary or constitutional tend- 
ency are the principal causes. 

Treatment. — Varies according to the cause. 
Remove the itching by the following application : 
Take 

Nitrate of argentum 10 grains. 

Water 4 oz. 

Mix. 

In the meantime apply mild zinc ointment to 
the affected surface. 
Take 

Syrup of iodide of manganese in half tea- 
spoonful doses thrice daily, and 
Take 

Chloride of gold and soda 1 grain. 

Sugar of milk % oz. 

Mix. 



Ecthyma. 459 

Make 80 powders. 

Dose — One every night (see precautionary rules, 
Lecture XVII). 

ECTHYMA. 

An eruption of large round pustules about the 
size of large peas rising from a bright red hard 
inflamed base and attended with sharp cutting 
pain and fever. The pustules are not very 
numerous and contain a yellowish purulent fluid 
often mingled with blood, succeeded by dark- 
colored scabs which leave red stains, disappear- 
ing after a time, or if the scabs continue, they 
often leave slight scars. They occur on the neck, 
shoulders, buttocks, limbs, or chest, seldom on 
the face and neck. The cause may be direct 
irritation of the skin, but it is chiefly due to a 
feeble state of the general health when there are 
successive crops of pustules with small ulcers 
under the scabs leaving a scar. It is not a very 
common disease. 

Treatment. — Apply mild zinc ointment to 
affected parts. 

Take 

Bichloride of platina 1 grain. 

Sugar of milk % oz. 

Mix. 

Make 30 powders. 

Dose — One every night. 

Syrup of iodide of iron % teaspoonful three 
times a day. New milk diet warm, if possible, 



460 Dr. J. KearCs Lectures. 

from the cow (see precautionary rules, Lecture 
XVII). 

ACNE. 

Red pimples occurring chiefly on the skin of 
the forehead, temple, and nose, most frequently 
after puberty. The pustules are due to obstruc- 
tion of a sebaceous duct, the secretion of which 
accumulating causes inflammation, the resulting 
pustule of which may lead to suppuration and 
bursting leave minute hard red tumors. The 
first indication of the affection is often the ac- 
cumulation of secretion in the sebaceous ducts, 
the end of which becomes dark-colored, and is 
popularly thought to be worms in the skin. A 
severe form of acne often occurs in tipplers, 
especially in dram-drinkers, and in women at the 
change of life, in which the face may become 
one red mass, the pimples touching each other 
and rising from a blue-red base. On the nose of 
liquor-drinkers it often forms small knobs and 
projections of a purplish-red color, giving a very 
unsightly appearance. 

Treatment. — Food should be simple and 
nourishing, avoiding alcoholic liquors, tea and 
coffee. Bread and milk poultices locally, with 
an ointment of iodide of sulphur 15 grains to an 
ounce of lard. 

CORNS 
Consist of a growth of the skin caused by the 
pressure or friction of tight or badly fitting boots 



Bunions. 461 

or shoes. A corn not only lies on the true skin, 
but its pressure causes the true skin to waste and 
the corn fills up the space, thus penetrating into 
the skin. Soft corns are those situated where the 
secretions of the skin are confined, as between 
the toes. 

TREATMENT. 

Take 

Bicarbonate of soda 2 oz. 

Warm water 4 pints. 

Mix. 

Soak the feet in this solution for half an hour, 
then pare the corn or raise it from the edge with 
the point of a knife ; in the centre will be found 
a white spot or root ; pick it ont with the point 
of a knife, and apply chromic acid 1 drop ; wear 
a piece of plaster with a hole in the centre over 
the middle of the corn. 

BUNIONS 

Are a painful swelling of the bursa or sac over 
the joint of the great toe, usually caused by the 
pressure of tight or ill-fitting boots or shoes. 
The pain, redness, and swelling soon subside on 
removal of the cause, but a permanent enlarge- 
ment is usually the result. 

Treatment. — A surgical operation is frequently 
necessary, hence employ only those of well-known 
ability; hot fomentations of muriate of ammo- 
nia and belladonna, as given in a previous page, 
and wear easy boots. 



462 Dr. J. Kermis Lectures. 

WARTS 
Are a collection ol enlarged papillse of the true 
skin covered by a scarf skin. They generally 
appear on the hands without any obvious cause 
and are not painful. 

Treatment. — Touch it every day with strong 
acetic acid, first paring off the decayed part, or a 
thread tied tightly round the base will remove 
it at once. 

FRECKLES 

Are yellowish or brownish-yellow spots which 
appear especially on fair skins and those exposed 
to the sun; they cause no annoyance and have 
no bad result. To get rid of them sponge the 
skin night and morning with a lotion of the fol- 
lowing : 

Take 

Solution of chlorinated soda % oz 

Glycerine 1% oz. 

Water 10 oz. 

Mix. 

Lemon juice and water, or a mixture of equal 
parts of lime water and oil, with five drops 
solution of ammonia to the ounce, have also 
been used effectually. 

BOILS 

Are small hard painful swellings on the skin 
which lead to suppuration. A red angry-looking 



Chilblains. 463 

spot appears at first, which gradually enlarges 
into a swelling with a whitish centre surrounded by 
a hard inflamed base ; after a time it suppurates 
and discharges a fibrous mass of dead skin form- 
ing the core, and which is the cause of the boil ; 
till it is discharged, and it often lies deep causing 
great pain, the abscess will not heal. Sometimes 
boils follow in rapid succession for a considerable 
time, occurring more usually in the strong and 
robust, and are due to errors in diet or living, 
such as insufficient pure air. 

Treatment. — Poultices till the boil softens, 
and then an incision to let out the pus. A piece 
of belladonna plaster at the beginning placed 
over the part at times prevents the formation of a 
boil; drawing a moistened stick of nitrate of 
silver twice over the spot may also prevent its 
formation. Nourishing diet for weakly persons, 
avoiding stimulants. A drachm of sulphate of 
magnesia in a tumbler of water every second day 
for full-blooded persons. Two tablespoonfuls of 
infusion of quassia and 2 grains of quinine daily 
for all cases where there is a succession of boils. 

CHILBLAINS 

Are a kind of low inflammation caused by sud- 
den changes from cold to heat, especially in 
weakly persons of languid circulation, in children, 
scrofulous people, and old age. A chilblain be- 



464 Dr. J. Kearts Lectures. 

gins with swelling, slight purplish redness, pain 
and itching, and may go on to form a blister, fol- 
lowed by ulceration. 

Treatment. — Before the chilblains are broken 
rub them gently with a lotion of the following : 
Take 

Alum 1 drachm. 

Sulphate of zinc 1 drachm. 

Spirits of wine % oz 

Water 4 oz. 

Mix. 

If they have broken, dress them with spermaceti 
ointment. To prevent chilblains nothing equals 
brisk exercise; for children, free use of a skip- 
ping-rope. Friction of the hands and feet with 
a rough towel after washing till they are thor- 
oughly dry. Avoid damp feet and sudden warm- 
ing of the hands and feet when cold. Wear 
woolen socks and gloves. 

INFECTIOUS SKIIST DISEASES. 
RINGWORM 
Is an affection of the hairs of the skin, scalp, or 
chin, usually of a circular or ring shape. The 
hairs become dry, brittle and tend to crack 
across or break off. At first there is itching with 
slight redness of the skin, which becomes covered 
with fine white powdery scales. The affection is 
due to the growth of a fine white powdery fungus 
growing in the interior of the roots of the hair. 
Tht hairs swell, become paler and brittle, break- 



Favus. 465 

ing off close to the head. The hair follicles in- 
flame and suppurate, killing the fungus in them, 
but also killing the hair bulb and leaving perma- 
nent baldness. There are three forms, one attack- 
ing the body (Tinea circinata), another attacking 
the beard (Tinea sycoris), and causing acne pim- 
ples, a third attacking the scalp (Tinea tonsurans), 
which is generally met with in children. 

Treatment. — The essential point is to destroy 
the fungus, by removing the diseased hairs with 
a pair of tweezers ; after washing with soap and 
water, apply tincture of cantharides, or a piece 
of lint soaked in a lotion of equal parts of gly- 
cerine and sulphurous acid and covered with a 
piece of oiled silk. The general health must be 
attended to, as the fungus grows more rapidly 
when the system is deranged. 

FAVUS 

Is a disease caused by the growth of a fungus, 
usually attacking the scalp and forming small 
dry sulphur-yellow cups, or crusts, each contain- 
ing a hair in its centre and resembling a piece 
of honeycomb. Like ringworm, it begins in the 
hair follicles, but outside the sheath, and is at- 
tended with severe itching, the hairs becoming 
brittle and falling out, and is accompanied by a 
mouldy odor. Sometimes it grows beneath the 
nails, and gradually eats through them, a yellow 
cup appearing in the opening. 

30 



466 Dr. J. Kean's Lectures. 

Treatment — As in ringworm, is directed to 
destroy the fungus. Shave the head, and apply 
poultices till the crusts are displaced ; following 
this, apply tar ointment twice a day, washing off 
the preceding supply of ointment each time with 
soft soap and rain water. 

BALD SPOTS. 

Round or oval bald patches on the scalp, per- 
fectly smooth and white, by many supposed due 
to a fungus. 

Treatment. — The same as ringworm. 

LIVER SPOTS 
Are brow r nish-yellow or yellowish-brown colored 
spots on the body or arms, which are coverd with 
small branny scales, and are due to the growth of 
a fungus. 

Treatment. — Wash twice a day with soft soap 
and water, and use a lotion of equal parts of 
sulphurous acid and glycerine. 

SCABIES 
(Itch) 
Consists of an eruption of little pimples or vesi- 
cles from the irritation caused by the burrowing 
underneath the scarf skin of the itch insect. It 
attacks the delicate parts of the skin most, be- 
tween the fingers, the wrists, bends of the joints, 
armpits, etc. The first thing noticed is itching, 



Scabies. 467 

increasing at night and followed by the appear- 
ance of the eruption. The eggs are laid in 
burrows made in the skin, and are hatched in 
eight days, the burrows appearing like fine 
scratches from a small needle. 

Treatment — Is directed to destroying the 
itch insect and its eggs. If there is much irrita- 
tion of the skin, warm baths. At bedtime scrub 
the whole body except the head with black soap 
(soft) for half an hour ; take a hot bath for another 
half-hour, then after drying rub all the body 
except the head with sulphur ointment for twenty 
minutes, and let remain on all night, wash it oft 
with a hot bath in the morning ; repeat this pro- 
cess for two more nights, when the cure ought to 
be complete. All clothing must be scalded with 
boiling water or ironed with a hot iron, as one 
insect escaping destruction might engender dis- 
ease again. 




Fig. 48 —Food. 



LECTURE XIII. 

Diseases and Management of Children— Diet.— Clean- 
liness.— Sleep.— Clothing.— Teething.— Chafing.— Flat- 
ulence. — Griping. — Convulsions. — Diarrhoea. — Red 
Gum. — Thrush. — Vomiting. 

DISEASES AND MANAGEMENT 
OF CHILDKEN. 

FOOD. 
TTTHE diet of the infant is indicated by nature 
JL with unerring wisdom. The changes in the 
mouth show when a change to other food 
than milk is desirable. From birth till seven 
months of age, when the teeth begin to appear, 
the mother's milk should be the only food, pro- 
vided it is sufficient in quantity and good in 
quality. A mother generally suckles her baby 
too often, a practice which is injurious both to 
the mother and child; the over-feeding causes 
indigestion, and the child is consequently in 
pain and cries, which is too frequently quieted by 
giving it the breast again. It is a great mistake 
to consider an infant's crying as a sure sign of 
an empty stomach. Crying is the infant's only 
method of expressing all disagreeable sensations : 
if it is hungry it cries, if over-fed it cries, if held 
too long in one position so as to cause undue 



470 Dr. J. Keari's Lectures. 

pressure on one part, if exposed to cold, if its 
dress is too tight, if pricked by a pin, or if 
exposed to too bright a light or a very loud 
sound, it cries, when generally the same universal 
remedy is used — applying it to the breast. An 
infant should have its food at regular intervals, 
as adults, during the first month every hour-and- 
a-half during the day, and thrice during the 
night; during the second month every two 
hours during the day. When the milk is not 
sufficient in quantity, cow's milk may be given. 
When an infant is reared by hand the unmixed 
milk of one cow should be used with a third 
part of water added and slightly sweetened so 
as to resemble the mother's milk. After seven 
months of age, on an average, the infant should 
begin to take small quantities of other food than 
milk, such as dried bread-crumbs rubbed to a fine 
powder, and baked in a slow oven to a light 
brown color, or thin slices of bread covered with 
cold water and baked in an oven for two hours, 
then beaten up with a fork and slightly sweet- 
ened, or the crust of a loaf boiled for one hour, 
broken up with a fork, and slightly sweetened, 
or baked flour — fine flour baked in an oven 
till of a light brown color ; it has a constipating 
tendency, and hence is best used mixed with 
one-half its weight of good oatmeal. Corn- 
starch may also be used in various ways. All 
the foregoing are best given freshly prepared 



Food. 471 

and mixed with milk. [See Fig. 49.] The 
proportion of farinaceous food should be gradu- 
ally increased till the infant is nine months old, 
when on an average it should be weaned, pro- 
longed suckling being hurtful both to mother and 




Fig. 49. — Nocjbishment. 

child, especially to the mother. Weaning should 
be gradual, a sudden change being injurious to 
the child and not less so to the mother. For the 
first three years the food should be farinaceous 
only, arrowroot, sago, rice, bread-crumb and the 



472 Br. J. KearVs Lectures, 

like with milk; animal food, such as soups, 
should only be given as articles of medicine. 
During the first seven years farinaceous food, 
such as bread, the lighter vegetables, with animal 
soup or broth, a mealy potato, and milk, should 
be the staple food, tender chop or steak being oc- 
casional varieties. After the seventh year, when 
the permanent teeth begin to appear, a due mix- 
ture of the various kinds of food is best. Chil- 
dren often over-feed themselves when tempted 
with toothsome dainties. Youths of both sexes 
require more food than adults, the growth of the 
body requiring to be provided for in addition to 
the food needed for sustenance. 

CLEANLINESS. 

An infant should be bathed once a day. Inat- 
tention to washing is a frequent cause of chafing 
of the skin ; soap should not be used every day 
because it combines with and washes away the 
natural oily secretion which keeps the skin soft 
and supple. The salts of perspiration can be wash- 
ed away with pure water (rain is preferable), and 
the excess of oily secretion may be removed by 
using soap twice a week ; frequent use of it leav- 
ing the skin harsh and dry. The water should 
be of mild temperature. Many persons use cold 
water and scanty clothing, with the idea of mak- 
ing their children hardy, which it certainly does 
— by killing off" the weaker ones. The child 



Sleep. 473 

should not be long in the bath, and as in all bath- 
ing, the skin should be thoroughly and quickly 
dried with a soft napkin. With older children, up- 
wards of four years of age, cold water may be 
used with advantage, except in winter when the 
chill should be taken off, and rubbing with a 
soft towel after the bath, but very delicate chil- 
dren may be unable to benefit by cold bathing at 
any age. 

For exercise, a child may be safely trusted to 
take as much as is good for it, and should spend 
a considerable time in the open air at play, ex- 
cept in wet or cold weather. 

SLEEP. 

For the first three months an infant's time is 
almost entirely spent in sleep ; it awakens when 
hungry, and being fed, goes to sleep again. For 
the first two months it should sleep with its 
mother for the sake of warmth, an infant's power 
of generating heat being very feeble, but after two 
months of age it is best to let it have a separate 
bed, by which it is less disturbed and has more 
certain access to pure air. No noise or talking 
should be allowed, because, even though it does 
not wake the child, it renders the sleep disturbed 
and unrefreshing. A piece of light muslin may 
be laid over the cradle to keep off flies and dust, 
but thick cloth must be avoided because it pre- 
vents a sufficient supply of pure air. The room 




BAKERGO 



Fig. 50.— Sleep, 



Teething. 475 

should be quiet and darkened during the 
day. The length of time required for sleep 
gradually diminishes as the child grows older. 
As long as the sleep is sound [see Fig. 50] 
and refreshing, it is not too long and is required, 
but dozing between waking and sleeping does 
more harm than good. 

CLOTHING 
Should be loose, warm, and light ; with delicate 
children fine flannel should be worn next the skin, 
and no pins except safety pins should be used in 
the dress of infants. The head ought to be kept 
cool, hence soft pillows and night-caps should be 
eschewed. The dress ought to come up to the 
neck ; one part being unprotected is more apt to 
give cold than insufficient clothing over the whole 
body. When changing from a warm room to the 
cold air additional clothing ought to be put on, 
but the habitual clothing and heat of the room 
ought not to be such as to excite perspiration 
or cause relaxation of the skin, as the first ex- 
posure to cold air is almost sure to give a cold. 

The essentials for health of infants and chil- 
dren are plenty of pure air, good milk, sleep, and 
plenty of water for the skin. 

TEETHING. 

As a rule an infant begins to cut its teeth at 
seven months of age, and is generally two years 
in cutting the whole set of milk teeth, usually in 



476 Dr. J. Kean's Lectures. 

the following order : 1, the two lower front teeth 
(incisors) ; 2, the two upper front teeth ; 3, the two 
upper teeth on each side of the front pair ; 4, two 
lower side incisors ; 5, the two lower first grinders ; 
6, the upper first grinders; 7, the lower canine 
teeth ; 8, the upper canine or eye-teeth, then the 
lower back grinders, and finally the upper back 
grinders ; but very often they do not follow this 
order. About seven years of age the milk teeth 
begin to fall out and are succeeded by the perma- 
nent teeth, which are thirty-two in number. Two 
more on each side of one jaw between the grind- 
ers and the canine or eye-teeth called the bicuspid 
teeth, and an extra grinder on each side called 
the wisdom teeth because they are not usually 
cut till after twenty years of age. The first indi- 
cation of the approach of teeth is a flow of 
saliva which trickles from the angles of the 
mouth. When an infant is in good health yet 
not over-fed, this being a fruitful source of difficult 
teething, the eruption of the teeth is compara- 
tively easy. Slight feverishness occurs for a day 
or two before each tooth appears, and at times the 
whole milk set appear without any trouble what- 
ever. If teething progress naturally there is no 
occasion for interference ; the child should have 
an india-rubber ring to bite on, the pressure ot 
which hastens the absorption of the gum over the 
approaching tooth. In painful teething the child 
is peevish and fretful ; the face is flushed and the 



Teething. 477 

skin hot ; the child places its fingers and every- 
thing it can reach into its mouth. If a tooth or 
teeth can be felt in the gum nearly through so 
that they would probably appear in a day or two, 
the gum lancet may be used to divide the gum 
over the tooth in the length of the gum and not 
across, but usually friction of the gums with the 
finger and a little syrup of roses will suffice. In 
severe teething the gums are red, hot, and swollen, 
and cannot be touched without pain ; the mouth 
is dry ; the child is restless, feverish, and starts in 
its sleep ; the head is hot and heavy, and it may 
have convulsions, purging, flatulence, or other 
disorder caused by the irritation of the teeth 
pressing on the gum. The gums should at once 
be lanced and the child pat into a warm bath at 
98° F. for ten to twenty minutes, when it should 
be taken out and thoroughly dried. 

During teething certain eruptions on the head 
are apt to appear, especially behind the ears; if 
they are moist, a little flour or violet powder 
may be dusted over them. When very dry a little 
glycerine will relieve the disagreeable or painful 
irritation ; should they continue after teething is 
completed, an alkaline lotion may be used twice 
a day, such as half a drachm of carbonate of 
soda to six ounces of rain water. Among the 
more frequent diseases during infancy are con- 
vulsions, chafings, flatulence, looseness of the 
bowels, gripings, red gum, vomiting, and thrush. 



478 Dr. J. Kean's Lectures. 

CHAFING OF THE SKIN 
Is usually caused by insufficient use of water. 
The part ought to be well sponged with tepid 
water and dried with a soft napkin, and after- 
wards sprinkled with some fine powder, such as 
powdered starch, violet powder, wheat-flour, ful- 
ler's earth, etc. 

CONVULSIONS 

Are alternate states of rapid contraction and re- 
laxation of the muscles, especially of the limbs, 
accompanied by unconsciousness. Great differ- 
ences in the liability to convulsions exist in dif. 
ferent children; in some families convulsions are 
unknown, while in others not a single child 
escapes. The causes are numerous, but the most 
common are irritation of teething, or a disordered 
state of the bowels, either from worms, too much 
food, indigestible food, unhealthy secretions, or 
quacking with drugs. All causes which tend to 
impair the general health favor the occurrence 
of convulsions, such as impure air, improper diet, 
etc. When a child previously in perfect health, 
and not known to be taking, or to have taken, 
indigestible food, becomes affected with convul- 
sions, an attack of eruptive fever, especially mea- 
sles, scarlet fever, or small pox, may be suspected. 
If the child be closely watched before the attack 
appears, the eyelids will be seen to be imperfectly 
closed during sleep, there are occasional twitch- 



Convulsions. 479 

ings of the face, and sudden startings with moan- 
ings or screams. When the fit comes on it gen- 
erally begins with the muscles of the face, the 
twitchings of which are more decided than form- 
erly, and in a few seconds the head and neck are 
drawn backwards, and the limbs, perhaps only 
on one side of the body, are bent and stretched 
out. The child is now unconscious and free from 
pain, the eye is fixed with a contracted or dilated 
pupil immovable to light, so that a finger or light 
may be brought near the eye without causing 
winking, and hearing is also lost so t^at the loud- 
est sound does not startle. The surface of the 
body is warm, with profuse perspiration; the 
pulse is quick and weak, the breathing hurried, 
and during the fit the bladder or bowels may be 
emptied ; vomiting frequently occurs. The aver- 
age duration of the attack in infants is from five 
to twenty minutes; when the fit subsides the 
child falls into a deep sleep, or may open its eyes 
apparently bewildered ; it may have a crying fit. 

Treatment. — Place the child in a warm bath 
at 98° F., or wrap in blankets wrung out from 
mustard and hot water. 
Take 

Fluid extract of gelsemium 10 drops. 

Tincture of aconite 30 drops. 

Water 4 oz. 

Mix. 

Dose — One teaspoonfui every hour. Lance the 
gums if necessary. 



480 Dr. J. KearCs Lectures. 

FLATULENCE 
Occurs chiefly in infants that are hand-fed (see 
Indigestion) ; may be relieved by gentle friction 
over the bowels with a warm hand anointed 
with turpentine and olive oil. In very severe 
flatulence a warm bath gives immediate relief. 
Avoid all soothing syrups and quack remedies 
which contain opium, as all are exceedingly 
dangerous to children. 

GRIPING. • 

The cause may proceed either from the infant 
or from the mother, and in either case is gen- 
erally due to improper feeding. The child 
screams and draws up its limbs. Its stools are 
slimy, curdled, or green and watery. 

Treatment — Is a warm bath followed by 3 
grains of compound rhubarb powder for a child 
under six months. Avoid all quack medicines 
as being dangerous, as also opiates and astringents. 

DIARRHCEA 

Is one of the most common and serious diseases 
of infants. An infant should have from three to 
six motions in twenty-four hours ; if the number 
of motions is increased to from six to eight in the 
twenty-four hours, and the child is otherwise 
well, it should not be interfered with, but if it 
continues more than three days, give of compound 
rhubarb powder 5 grains to a child one year old. 



Thrush. 481 

If the character of the stools change (the attack 
becoming one of dysentery)* to a dozen or 
more frothy, with blood and mucus, or violent 
griping, writhing and vomiting, the treatment 
requires to be the same as I have previously 
recommended for dysentery. 

BED GUM 

Consists of numerous little red pimples about the 
size of pins' heads, and may be distinguished 
from measles, the only thing it is at all likely to 
be mistaken for, by its lighter color, the pimples 
are not arranged in crescent-shaped patches, and 
the absence of the symptoms of a cold in the 
head. The cause is usually irritation of teething, 
and requires no treatment except to remove irri- 
tation (see previous treatment, page 453). 

THRUSH 

Consists of irregular milk-white patches inside 
the mouth, on the tongue and the angles of the 
mouth and on the lips, and is caused by the 
growth of a fungus. Under the white patches 
the skin is red and inflamed, but not ulcerated, 
the mouth is hot and painful, and the child is 
afraid to nurse. Occasionally the thrush extends 
into the bowels. The treatment, if the child is 
not suckled, is in the first instance great attention 
to cleanliness as regards the food ; fresh milk to 
be used at least twice a day. Locally honey and 



482 Dr. J. Kean's Lectures. 

borax to the white patches, and three grains of 
borax with two grains of sugar to be placed on 
the tongue every four hours. 

VOMITING. 

If the child is in good health it is due to over- 
nursing or teething. 

In almost all the painful affections of infancy 
warmth rightly applied in different ways is in- 
deed valuable, with the great advantage of very 
seldom doing any harm, and very often d,oing 
much good. All the other diseases of infancy 
beyond the special ones already mentioned, must 
be treated in accordance with the ordinary treat- 
ment of the disease, and will be found each under 
its own heading. 



LECTURE XIY. 

Old Age and Degeneration. 

ilSi 




(XLD AGE. 

YTFHE natural termination of life is by a pro- 

J X cess of gradual decay in which all the parts 

of the body become old together. A man's 

age is not always to be measured by his years, for 



484 



Dr. J. Kean's Lectures. 



some are aged even in their youth, while others 
are strong, vigorous and youthful till well along 
in years. As age approaches, whether in middle 
life or in advanced years, the tissues of the body 
begin to degenerate. Degenerations are such 




•Degeneration. 



changes as may be seen to take place naturally 
towards the end of life. The new material is 
lower in structure, that is nearer inorganic 
matter ; thus fat is lower than any nitrogenous 
organic compound, gelatin is lower than albu- 



Old Age and Degeneration. 485 

men, and earthy matter is lower than all. The 
degenerated part is lower in structure than the 
preceding structure ; thus the crystalline form in 
bones and oil globules for muscular fibre. In its 
function it has less power, and in its nutrition 
there is less frequent and active change, and 
there is no capacity of growth or development, 
all of which is the result of defect of nutrition 
[see Dyspepsia for use of stimulants in old age, 
page 387, and Fig. 51], and not of disease. 

The result of senile atrophy (wasting) is not 
the same in all persons : you may class them into 
the lean and the fat. [See Fig. 52]. 

Some people as they grow old seem to wither 
and dry up, sharp-featured, shrivelled, spinous 
old folk, yet withal wiry and tough, clinging to 
life. Women more often than men, as old and 
as ill nourished as these, yet make a far different 
appearance. With these the first sign of old age 
is that they grow fat. 

Treatment. — Rest, warmth, easily soluble 
food, not requiring much masticating and easily 
digested, in small quantity at one time. 




Fig. 53.— Preventing Hemorrhage. 



LECTURE XV. 

Local Injuries and Emergencies— Hemorrhage. — Bruis- 
es. — Burns aud Scalds. — Choking. — Incised Wounds. — 
Dislocations and Fractures. — Sprains. — Drowning. 

LOCAii injuries and emer- 
gencies. 

hemorrhage. 

(Bleeding.) 

WHEN it occurs from a cut or wound, it 
should be arrested not by a cloth or band- 
age applied at large over it, but a small 
part folded up to the size of the wound should 
be laid over it, another slightly larger over 
this, and then a bandage of any kind. A 
slight force stops the flow if properly ap- 
plied. When an artery is wounded the blood 
spurts out in jets, and is light scarlet; if a 
vein is wounded it flows out continuously, of a 
dark color. A large wound or cut artery in a 
limb is most easily and thoroughly stopped by a 
piece of india-rubber tube pulled tightly around 
the limb five or six times. If a small artery is 
cut across, it stops bleeding after a short time, 
but if it is merely wounded, it may continue 



488 Dr. J. Kean's Lectures. 

bleeding till the patient expires. No time should 
be lost in procuring the assistance of a surgeon 
whose qualifications have been fully proven by 
his past success; prolonged pressure, for more 
than twenty-four hours, from a tube or bandage 
would cause death of the limb. If a surgeon 
cannot be had, an attempt must be made to tie 
the artery : the wound should be opened and the 
bandage or tube relaxed till the blood spurts out, 
when the bleeding point should be grasped with 
a pair of tweezers or anything available, and a 
thread tied firmly round the bleeding point be- 
low the grasp of the tweezers. The edges of the 
wound may be brought together by plaster, or 
sewing the skin with white silk thread or silver 
wire. Bleeding from small wounds may be 
stopped by persulphate of iron [see Fig. 53], or 
by touching them with a stick of nitrate of silver 
(caustic). 

BRUISES. 

In all injuries and inflammations the first re- 
quisite is rest to the part. If fainting has followed 
the infliction of a bruise, the patient should be 
kept lying down, and a small amount of wine or 
brandy cautiously given. In less severe injuries 
when swelling, pain, and stiffness are the worst 
results, hot fomentations, and a lotion of dilute 
solution of sub-acetate of lead, with four grains of 
opium to half a pint of lotion. When the pain 



Burns and Scalds. 489 

has subsided, an evaporating lotion should be 
used of chloride of ammonium four grains to an 
ounce of rain water, with half a drachm of spirits 
of wine. 

BURNS AND SCALDS. 

Burns are produced by heated solids, scalds by 
heated liquids. The danger is in direct propor- 
tion to the amount of skin affected, an extensive 
slight burn being more dangerous than a severe 
small burn. The best application is a continu- 
ous bath of cold water with a pound of bicarbon- 
ate of soda to a gallon of water, into which the 
limb should at once be plunged, and kept in it 
for some hours, or the body clothes dipped in 
the cold water, and soda should be applied ; or 
coat the surface over with a layer of powdered 
alum. If the pain and shock continue extreme, 30 
drops of laudanum in a glass of wine or brandy 
may be necessary. When blisters form and be- 
come tense, same of the fluid should be let out by 
pricking the blister with a needle. After 
removal from the cold bath the limb should 
at once be wrapped in a thick layer of cotton- 
wool, which acts as an antiseptic filter to the germs 
in the air, and also prevents rapid changes of 
temperature which are always trying to weaken- 
ed parts. As in all inflammations, it must be kept 
absolutely at rest. When it extends to suppura- 
tion it should be dressed twice a day with strips 



490 Dr. J. Kean's Lectures. 

of lint soaked in a mixture of equal parts of 
linseed oil and lime-water shaken up together to 
form an emulsion. Cream is a natural emulsion 
of butter, the separate particles of which contain 
the butter in a fluid or melted state, and which 
does not become solid till the surrounding mem- 
brane is broken by churning or chemical changes. 
A still better application in many cases is the 
following : 
Take 

Olive oil 1 oz. 

Carbolic acid 20 drops. 

Mix. 

And apply to the affected parts by means of soft 
cloths. If olive oil is not at hand, linseed oil. 
In small burns such as of the fingers, one of the 
best applications is a stiff paste of whiting or fine 
chalk and water applied at once like a small 
poultice, and kept on for a day till all pain 
ceases. 

CHOKING. 
If a person is being choked on a piece of hard 
food, try to remove it with the fingers put well 
into the back of the throat; if this cannot be 
done, and there is danger of suffocation, it may 
be pushed gently down into the stomach, while 
the head is held back with the face looking 
slightly upwards, which is best performed by 
surgical instruments. A smart pat on the back in 
less serious cases may suffice, but the sensation of 



Dislocations and Fractures. 491 

something foreign in the throat remains for some 
time after it has passed into the stomach. When 
a hard substance becomes fast in the throat 
which frequently happens with children, turn the 
child bodily with head down, holding it by the 
nether limbs and let another slap it on the back ; 
if this fails, an attempt may be made to remove 
the substance with a loop of fine wire. 

INCISED WOUNDS. 

(Cuts.) 

If not clean cut with a knife, any glass, hairs or 
dirt should be removed and the edges brought 
together and kept so by a piece of sticking-plas- 
ter or a bandage. 

DISLOCATIONS AND FRACTURES. 

Dislocation is when the end of a bene is 
removed from its position in a joint. Fracture is 
when a bone is broken ; if an end projects or there 
is an external opening extending down to the 
seat of fracture, it is a compound fracture. The 
sooner the bones are replaced the better and the 
more easily it is performed. If a surgeon cannot 
be procured till several days elapse, endeavor 
gently to replace the bones in their natural posi- 
tion, comparing the injured side with the unaflect- 
ed one, and wheu this has been done apply a 
piece of wood as a splint, well padded with cot- 
ton-wool, and pass many turns of a bandage round 




Fig. 54.- Sprain. 



Sprains. 493 

the limb and spliut firmly, but not so tight as to 
cause any pain or compression of the limb. Sev- 
eral folds of moist brown paper, which hardens 
as it dries, makes a very good and well fitting 
splint, but the limb must Dot be moved till it has 
time to dry. Keep the limb perfectly at rest and 
await the arrival of a surgeon whose qualifica- 
tions have been fully proven by his past success. 

SPRAINS 

Are produced by the over-stretching or tearing of 
the muscles, tendons, or ligaments in the neigh- 
borhood of a joint, often attended with severe 
pain, swelling, and discoloration. The great rem- 
edy is complete rest for days to avoid a disabled 
condition for weeks or months. Sprains com- 
paratively slight at first may by using the limb 
be greatly aggravated and prolonged. A severe 
sprain is often very much longer in healing than 
a broken bone. [See Fig. 54.] I have known 
slight sprains where the limb was persistently 
used at first to remain over a year. The treat- 
ment is to apply the following : 
Take 

Tincture of arnica 1 oz. 

Tincture of myrrh 1 oz. 

Mix. 

And a padded splint secured with a bandage at 
the very first. If there is much pain and swell- 
ing, warm fomentations. 



494 Dr. J. Kean's Lectures. 

DROWNING. 

The following are among the most excellent 
rules for the restoration of the apparently 
drowned : 

Send immediately for medical assistance, blan- 
kets, and dry clothing, but proceed to treat the 
patient instantly in the open air, with the face 
downward, whether on shore or afloat ; exposing 
the face, neck and chest to the wind, except in 
severe weather, and removing all tight clothing 
from the neck and chest, especially the sus- 
penders. 

First, the restoration of breathing ; second, the 
promotion of warmth and circulation. 

The efforts to restore breathing must be com- 
menced immediately and energetically, and per- 
severed in for one or two hours, or until a 
physician has pronounced life extinct. Efforts 
to promote warmth and circulation, beyond 
removing the wet clothes and drying the skin, 
must not be made until the first appearance of 
natural respiration; for if circulation of the 
blood be induced before breathing has recom- 
menced, the restoration to life will be endangered. 

To Clear the Throat. — Place the patient on the 
floor or ground with the face downwards, and 
one of the arms under the forehead, in which 
position all fluids will more readily escape by the 
mouth, and the tongue itself will fall forward, 
leaving the entrance into the windpipe free. 



Drowning. 495 

Assist this operation by wiping and cleansing 
the mouth. 

If satisfactory respiration commences, use the 
treatment to promote warmth. If there be only 
slight or no respiration, or if it fail, then — 

To Excite Breathing — Turn the patient well 
and instantly on the side, supporting the head, 
and excite the nostrils with powdered capsicum 
or carbonate of ammonia, etc. Rub the chest 
and face warm, and dash cold water, or cold and 
hot water alternately, on them. If there be no suc- 
cess, lose not a moment, but instantly proceed to — 

Place the patient on the back on a flat surface ; 
raise and support the head and shoulders on a 
cushion or folded article of dress. 

Keep the patient's tongue projecting beyond 
the lips, and by closing the teeth they may be 
made to retain the tongue in that position. 
Remove all clothing from the neck and chest. 

Grasp the arms just above the elbows, and 
draw them gently and steadily up above the 
head and keep them stretched ; then press down 
the patient's arms gently and firmly against the 
side of the chest. 

Repeat these measures alternately, deliberately 
and perseveringly, about fifteen times in a minute, 
until a spontaneous effort to respire is perceived, 
immediately upon discovery of which, cease to 
imitate the movements of breathing, and proceed 
to induce circulation and warmth. 



496 Dr. J. Kean's Lectures. 

To Promote Warmth and Circulation — Com- 
mence rubbing the limbs upwards, with firm, 
grasping pressure and energy, using handker- 
chiefs, flannels, etc. The friction must be con- 
tinued under the blanket or over the dry clothing. 

Promote the warmth of the body by the appli- 
cation of hot flannels, etc., to the stomach, the 
arm-pits, between the thighs, and to the soles of 
the feet. 

If the patient has been carried to a house after 
respiration has been restored, let the air circulate 
freely about the room. 

On restoration, a teaspoonful of warm brandy- 
and-water or coffee should be administered, the 
patient kept in bed and sleep encouraged. 

The above treatment should be persevered in 
for some hours, as it is an erroneous opinion 
that sufferers of this misfortune are irrecoverable 
because life does not soon make its reappearance, 
persons having been restored after persevering 
for many hours. 

Appearances which generally Accompany Death : 
Breathing and the heart's action cease entirely ; 
the eyelids are generally half closed ; the pupils 
dilated ; the tongue approaches to the under edges 
of the lips, and these, as well as the nostrils, are 
covered with a frothy mucus. Coldness and pal- 
lor of surface increase. 

Prevent unnecessary crowding of persons round 
the body, especially if in an apartment. 



Drowning. 497 

Avoid rough usage, and do not allow the body- 
to remain on the back unless the tongue is 
secured. 

Under no circumstances hold the body up by 
the feet. 

On no account place the body in a warm bath 
unless under direction of a physician with a 
reputation of skill and ability, and even then 
it should only be employed as a momentary 
excitant. 



32 




Fig. 55.— Alkaline Springs. 



LECTURE XVI. 



Alkaline Springs — Author prospected to find, near 
Chicago. — Difficult to Discover. — Finally one of great 
medical value is reached.— Result of Analysis.— Pa- 
tients repair thither. — Baths free of charge. — Easy ac- 
cess hy railroad. — Beautiful Scenery. —Tine Atmo- 
sphere.— Most Healthy Summer Report.— Commanding 
View over miles of Country. 



AliKAIilXE SPRIXGS. 

IT having been suggested to the author by many 
patients at different times through his prac- 
tice, that he should select some suitable point 
and as near Chicago as could be found, to which 
he could send those under his treatment, while in 
a convalescent condition, etc., he conceived the 
notion of prospecting in various directions from 
the city for mineral wells, or springs, and accord- 
ingly from time to time, at great outlay in test- 
ing different waters, he made several unsuccessful 
searches. Thus failing in his repeated endeavors, 
he had about resolved to abandon what appeared 
to be a vain and fruitless undertaking, but upon 
a later occasion, while attending professional 
calls a short distance southwest from Chicago, his 
attention was attracted to a peculiar jet of water 
gushing from the side of a steep elevation, rising 



500 Dr. J. Kea?i's Lectures. 

almost perpendicularly from the bottom of a 
ravine of strange and picturesque formation. 
[See Fig. 55.] 

Procuring a portion of the water and applying 
a qualitative test, it readily yielded a large per- 
centage of magnesia, iron, and traces of various 
rare medicinal properties. 

In viewing the surroundings and adaptation to 
the proper care of invalids, in the meantime im- 
pressed with the, many indispensable advantages 
which were at once apparent, the author then 
determined upon leasing or purchasing a tract of 
land there embracing the spring. 

Finally, after the interchange of various pro- 
positions with different owners of lands in the 
vicinity, the author purchased, at a cost of nearly 
$50,000, two hundred acres, in the upper portion 
of which this spring is situated, and is now bene- 
ficially employed for the relief of invalids, who 
drink of and bathe in its waters, the curative 
properties of which have been abundantly dem- 
onstrated in every case. 

Subscribers to this book who desire to avail 
themselves of the medicinal virtues of this 
mineral fount, can at any time sojourn there and 
drink deep of its waters, and bathe to heart's con- 
tent, free of any charge. 

Easy access to the place is afforded by the Chi- 
cago, Alton and St. Louis Railroad, which has 
recently established a branch depot at Mt. Forest, 



Alkaline Springs. 501 

a young and flourishing town that bids fair to 
eclipse all others in the State as a summer resort. 
The Spring is located at this place, with an al- 
titude of about 125 feet above the level of the Aux 
Plaines River, a half mile distant, and possesses 
the attractive advantages of a salubrious atmos- 
phere, walks and drives through diversified groves, 
from which beautiful vistas lead away into the 
dim distance. 

All these are facts which combine to render 
this resort one of priceless value to the invalid, 
and to the overworked thousands who seek and 
need rest and recreation. 



LECTUEE XVII. 

Poisons — Their Effects and Treatment. — Alcohol. — Digit- 
alis. — Ergot. — Strychnine. — Arsenic. — Antimony.— 
Brassfounders'' A^ue. — Chromates. — Copper Colic. — 
Iodine. — Lead Colic and Palsy.— Mercury.— Phosphor- 
us. — Nitrate of Silver.— Gases.— Mineral Acids. — Alka- 
lies. — Metals.— Narcotics.— Deliriants.— - Inebriants.— 
Convulsives. — Depressants.— Cantharides.— Stings and 
Bites.— Adulterations.— Precautionary Rules. 

POISONS: THEIR EFFECTS A^TD 
TREATMENT. 

CHRONIC POISONING: 

Cumulative Poisons. 

(Continuous Small Doses Produce an Increasing Effect.) 
ALCOHOL. 

DELIRIUM TREMENS.— Morbid effects pro- 
duced by the slow and cumulative action • 
of alcohol. Delirium may appear after a 
long course of dram-drinking, or after a single 
protracted debauch. The patient becomes pale 
and chilly and partially delirious, being worst 
during the night. He is excited, eager, rest- 
less and sleepless, and becomes timid, sus- 
picious and jealous of all around him; he 
imagines that his business is ruined, his 
friends plotting against him, that there are 
listeners outside the door, under the bed, or con- 
cealed by the curtains. He may make violent 



Alcohol. 503 

efforts to escape from imaginary danger or 
enemies. If he sleeps for a short time he is 
haunted by frightful dreams, causing him to 
scream out in terror. He is constantly muttering 
and talking, and suffers from various hallucina- 
tions, and shrieks, raves, prays and curses, all in 
one breath. In favorable cases there is sound 
sleep, lasting for twelve or more hours, when he 
begins to recover generally in forty to eighty hours 
from the commencement. In fatal cases the sleep- 
lessness continues, the delirium becomes low and 
muttering, he lies picking the bedclothes with 
trembling fingers and constant twitchings of the 
muscles, which gradually passes into stupor and 
death usually between the third and seventh day. 
The tremulous tongue is coated with a thick 
creamy fur; there is loss of appetite, sickness 
and constipation ; there is tremor of the muscles 
and tendons so that he cannot hold out his hand 
steadily when requested to do so; the skin is 
cool, and exhales a peculiar spirituous odor; 
the pulse quick and weak, and there is general 
mental and bodily prostration. 

Treatment. — The danger is from exhaustion, 
and the treatment is directed to preserve the 
strength till the alcohol has time to leave the sys- 
tem. The patient should be kept in a cool, quiet, 
darkened room, and never left alone. Restraint is 
rarely necessary, and is to be avoided from irri- 
tating the patient and increasing his excitement. 



504 Br. J. Kean's Lectures. 

The food must be nourishing, and given often — 
milk, yolk of eggs, beef-tea, soups, and the like, 
spiced with cayenne pepper. Small pieces of 
ice may be taken to soothe the irritability of the 
stomach, and half an ounce of cream of tartar, 
dissolved in boiling water and flavored with 
sugar and lemon, given as a drink daily for the 
first two days. Powdered capsicum 4 grains 
should be given daily, either in soup or pill, and 
to procure sleep, as much as 20 grains, or half a 
small teaspoonful, is of use in the early stages. 

DIGITALIS. 
(Common Foxglove.) 

When given medicinally it accumulates in the 
system, unless precautions be taken, and may 
cause death from sudden stoppage of the heart. 
Patients taking it should not exert themselves, 
and should keep lying down, if a large quantity 
has been taken, till it has had time to pass off. 
It should always be given with a diuretic. 
EKGOT. 

Ergotism. — Ergot is a fungus which grows 
chiefly on rye and wheat, and when ground 
with the grain and eaten for some time it pro- 
duces convulsions, mortification of the fingers or 
toes, and death, or continued ill-health. The 
mortification begins in one or both feet, with 
pain, redness, and a burning sensation which 
ceases suddenly after some days, and is replaced 
by a feeling of cold. The part affected becomes 



Metals. 505 

black and dry. This effect is due to the action 
of ergot causing contraction of the small arteries, 
and the mortification resembles that of old 
age produced by choking of the arteries from 
atheroma. 

Treatment. — Find out and remove the source 
of the ergot, usually bad bread. Give a purga- 
tive to remove all in the bowels, such as cream of 
tartar, half an ounce; followed by tonics and stim- 
ulants and opiates to soothe the inflamed parts, 
and relax the contracted vessels, such as the 
following : 
Take 

Chlorate of potash 1 oz. 

Carbonate of ammonia 3^ oz - 

Laudanum % oz. 

Infusion of calumba 12 oz. 

Mix. 

Dose — Two tablespoonfuls ; to be taken three 
times a day. 

STRYCHNIA. 

After some time it causes sudden twitching of 
the muscles and starting of the limbs during 
sleep, so as to awaken the patient. 

Treatment.— Discontinue its use. 

METALS. 
ARSENIC. 

(Its use has been strenuously avoided through all 
the author' 8 practice.) 
Chronic poisoning with arsenic usually occurs 
among workmen who have to do with it, or acci- 



506 Dr. J. Kearis Lectures. 

dentally from green wall papers, etc. It produces 
a long and varied train of symptoms, the first ol 
which are itching and swelling of the eyelids, 
redness of the white of the eyes (conjunctivae) 
sickness, and uneasiness at the stomach, at times 
vomiting, and a peculiar white, silvery appear- 
ance of the tongue, which is seldom accompanied 
with tenderness. Some constitutions can become 
accustomed to the poison, and are not greatly injur- 
ed by doses which would be certainly fatal to most 
people ; thus there is a race of arsenic-eaters who, 
beginning with small doses, gradually increase 
them till they take an enormous amount, and 
suffer from it in consequence. 

Treatment. — Find out the source of the 
arsenic ; if in green wall-papers or dresses, etc. 

Take 

Tincture of iron .10 drops 

three times a day. 

ANTIMONY 

(Its use has been strenuously avoided through all 
the author's practice) 

Produces great depression of the circulation and 
system generally. The symptoms are not unlike 
typhoid fever — sickness, vomiting, purging, ex- 
treme weakness, and fatal exhaustion. Externally 
applied it causes pustules on the skin. 

Treatment. — Carbonate of iron, three grains 
thrice daily. 



Copper. 507 

BRASSFOUNDERS 1 AGUE 

Is a peculiar intermittent fever occurring among 
brassfounders and those exposed to the fumes of 
zinc. The paroxysms occur irregularly, with 
tightness at the chest, towards evening chills, an 
indistinct hot stage, and profuse perspiration. 

Treatment. — Free use of new milk, warm, if 
possible, from the cow, and 

Take 

Powdered capsicum 3 grains. 

Powdered leptandrin 8 grains. 

Sulphate of quinine 10 grains. 

Mix. 

Make three powders. 

Dose — One every two hours, commencing six 
hours before the expected chill. 

CHROMATES. 
Workmen in factories where chromates are 
used are subject to a peculiar ulceration and loss 
of the cartilage forming division between the nos- 
trils. 

TREATMENT. 

Take 

Dilute sulphuric acid 10 drops 

in a glass of water, three times a day. 

COPPER. 

Workers in copper are subject to copper colic 
(see Colic) ; the attacks of pain occur suddenly, 
and are made worse by pressure. The pain is of 



508 Dr. J. Kean y s Lectures. 

a twisting or griping character, and is often ac- 
companied with sickness and vomiting. The 
face has an anxious expression, and a peculiar 
sallow color, the eyes are sunken, and the lips 
livid, and there is a green or purple color round 
the gums. 

TREATMENT. 

Take 

Sulphate of magnesia .\ oz 

Dilute sulphuric acid 2 drops 

Mix. 

the whole in a tumbler of water twice a day. A 
mustard poultice over the abdomen for ten min- 
utes, and of laudanum 20 drops, to relieve the 
pain. 

IODINE. 

The first effects are a pricking pain in the eyes, 
and a flowing of tears, a discharge from the nose 
like a common cold, pricking pain at the stom- 
ach, and general depression. 

Treatment. — Take tincture of iron, 10 drops 
three times a day. 

LEAD-COLIC AND PALSY 

(Lead is never used by the author as an internal 
remedy) 

May be produced by drinking water which 
has stood for some time in leaden pipes, 
as well as by handling preparations of lead. 
There is impaired digestion, wasting, and sal- 
lowness of the skin, with ulceration and a 



Lead-Colic and Palsy. 509 

peculiar blue or grey line round the margin 
of the gums, but absent wherever there is 
a tooth missing. Occasional attacks of colic 
occur along with thirst, vomiting, tenderness 
over the abdomen, severe grinding or twist- 
ing pain round the navel, which is relieved, by 
firm pressure, great prostration, cold sweats, and 
giddiness. The constipation may continue from 
three to fifteen days, but as soon as the bowels 
act the severity of the attack abates, and the dis- 
ease generally terminates within a week. When 
palsy occurs, which generally requires a larger 
dose than will produce colic, it first attacks the 
muscles of the hands and arms ; the extending 
muscles of the hands and arms become par- 
alyzed, so that when the arms are stretched out. 
the hands hang down by their own weight, hence 
it is called wrist-drop. The muscles of the ball 
of the thumb waste, and there are cramps of the 
joints with repeated attacks of colic. The course 
of the palsy is always long ; it often continues 
many months or even years. If lead is taken in 
by the skin from ointments, many months and 
even years, may be required to produce its pois- 
onous effects. The lead becomes combined with 
the various organs and tissues of the body, most 
being found in the spleen and liver, and it passes 
very slowly off by the urine. 

Treatment. — G-elsemiuni, 2 drops, thrice daily, 
or the following: 



510 Dr. J. Kearfs Lectures. 

Take 

Sulphate of magnesia 1 oz. 

Dilute sulphuric acid 40 drops. 

Fluid extract of hyoscyarnus M oz. 

Camphor water 4 oz. 

Mix. 

Dose — One-half ounce every four hours ; con- 
tinue until the bowels move gently ; followed by, 

Take 

Iodide potash 3rf oz - 

Tincture of iodine 5 drops 

Water 8 oz. 

Mix. 

Dose — One teaspoonful thrice daily, until a per- 
manent cure is effected. (See precautionary rules, 
page 525.) 

MERCURY. 

(Its use has been strenuously avoided through all 

the author's practice, an example that should 

be followed by all practitioners.) 

Workers with mercury, such as gilders, are 
frequently affected, generally from inhaling 
the vapor. The effects are, profuse flow of 
saliva, at times amounting to pints, swell- 
ing of the tongue and salivary glands, ulcer- 
ation of the gums and membranes of the 
mouth, with a blue or dark-red line at the 
junction of the gums and teeth, loosening and 
brittleness of the teeth, and even death of parts 
of the jaw, foetor of the breath, excessive purg- 
ing, colicky pains, great wasting and bloodless- 
ness, inflammation of the membranes of the 
bones, low fever, and great prostration, neuralgic 



Ca/rbonic Acid Gas. 511 

pains, trembling, paralysis, and sometimes con- 
vulsions with failure of the mental powers, and 
death. 

Treatment. — Good nourishing diet, warm 
clothing, and fresh air. Remove from the in- 
fluence of mercury ; take iodide of potassium, 3 
grains thrice daily; white of an egg, in water, 
thrice daily; tincture of iron, 10 drops, three 
times a day, after food, to be taken on alternate 
days with the iodide of potash. 

PHOSPHORUS. 

Burning pain at the stomach, fatty liver, with 
jaundice, and when prolonged, death of part of 
the lower jaw-bone. 

Treatment. — Abstain from phosphorus. 

ACUTE POISONING. 

CARBONIC ACID GAS. 

Carbonic acid gas, when mixed with air, does 
not act as a poison, but causes suffocation from 
want of oxygen. When persons fall into an old 
well, or brewer's vat, in which carbonic acid gas 
accumulates, a temporary expedient for rescuers 
would be to breathe through freshly-slacked 
lime; spread the lime on a towel and place a 
small basket over it, round which draw the 
edges of the towel and breathe from a short piece 
of pipe ending in the basket. The lime com- 



512 Dr. J. Kean's Lectures. 

bines with the carbonic acid to form carbonate of 
lime, and leaves the oxygen in proper quantity. 
This does not apply to fumes of burning, as col- 
liery explosions, limekilns, etc., owing to the 
presence of carbonic oxide, which is unaffected 
by the lime. The usual symptoms of poisoning 
by carbonic acid are a sense of weight in the 
forehead and back of the head, tightness in the 
temples, violent headache, giddiness, ringing in 
the ears, dimness of sight, drowsiness, hurried 
breathing, violent palpitation, sickness and vomit- 
ing, followed by insensibility, slow pulse, snoring 
breathing, pale and livid-colored face. In drown- 
ing it gives rise to pleasurable sensations and 
early delirium. 

Goal Gas, Garbonic Oxide, Glmrcoal Fumes, etc., 
are chemical poisons. 

Treatment is artificial respiration and a free 
draught of cold air. 

SULPHURETTED HYDROGEN GAS 
Is a very active poison, less than two volumes 
per thousand destroying life. The gas has the 
peculiar, offensive odor of rotten eggs. The 
symptoms are giddiness, tightness across the 
forehead, sickness, weakness, cold skin, delirious 
convulsions, and tetanus. 

Treatment. — Inhale very dilute chlorine gas, 
which can be made by pouring some dilute acid 
on common bleaching powder, so-called chloride 
of lime. 



Mineral Acids. 513 

IRRITANT GASES. 
(Vapor of Sulphuric, Nitric, and Hydrochlo- 
ric Acids, with Chlorine and Ammonia) 
When breathed for any length of time, unless 
largely diluted, may cause death by exciting 
fatal inflammation of the air passages. 

Treatment. — For the vapors of acids breathe 
dilute ammonia, the vapor over an ordinary 
smelling-salts bottle; for chlorine, very dilute 
sulphuretted hydrogen; for ammonia, steam of 
vinegar and hot water. 

MINERAL ACIDS. 
(Sulphuric, Nitric, and Hydrochloric Acids.) 

Large dose causes death on the average within 
twenty-four hours ; have a sour taste and cause a 
burning pain in the mouth and throat when 
taken in poisonous doses, followed by excruciating 
pain in the stomach, eructations, vomiting of 
brownish or blackish matter; swallowing is pain- 
ful or impossible ; there is intense thirst, anxious 
face, small quick pulse, catching, labored breath- 
ing, scanty urine, constipated bowels. The 
mouth is white and shrivelled, yellow or brown 
and corroded; if the sufferer recovers he may 
remain a dyspeptic for life from destruction of 
a part of the lining of the stomach. 

Treatment. — Magnesia, chalk or whiting in 
milk, olive oil, any alkaline (soda, potash, lithia, 

33 



514 Dr. J. Kearts Lectures. 

ammonia). The antidotes should be given freely, 
diluted, for some hours. 

VEGETABLE ACIDS. 

(Oxalic Acids and its Salts, 

sold as Salts of Lemon, Sorrel, Etc.) 

The symptoms are variable: an intense sour 
taste, burning pain at the stomach, increased on 
pressure ; constriction at the throat, purging and 
vomiting tinged with blood, and the general 
symptoms of weakness and collapse. Death has 
been caused by less than half an ounce, and may 
occur within ten minutes. 

Treatment. — Chalk or magnesia in water, 
lime water, oil. 

Tartaric and Citric Acids. — Are poisonous in 
large doses, from irritation of the stomach. 

Treatment. — Chalk, magnesia, or bicarbonates 
of soda and potash, diffused or dissolved in water. 

Hydrocyanic or Prussic Acid, like ammonia, is 
a vapor which for use is kept dissolved in water. 
It is also contained in cherry-laurel water, oil ot 
bitter almonds, and its salts — cyanides or prussi- 
ates of potash. 

A large dose may cause death in two to five 
minutes, smaller ones within an hour. The symp- 
toms are loss of consciousness, difficulty of 
breathing, with snoring sounds and convulsions. 

Treatment. — Dilute chlorine gas to be inhaled, 
cold water to be poured in a stream on the head 



Alkalies. 515 

from a height of three feet till consciousness 

returns. 

ALKALIES. 

(Caustic Potash and Soda, Strong Ammonia. 

Potashes and Pearlashes. Carbon- 
ates of Potash and Soda.) 

Symptoms are a strong acrid burning taste in 
swallowing, followed by acute pain and great 
tenderness of the stomach, increased by pressure, 
along with frequent vomiting of brownish matter, 
violent colicky pains, swelling of the abdomen, 
purging of stringy mucus mixed with blood, 
difficulty of swallowing, hoarseness of voice and 
cough succeed. In cases which become chronic 
the sufferer may die of starvation from stricture 
or narrowing of the throat. 

Treatment. — Acid drinks or oil. which forms 
a soap with the alkali. 

Alton, BleaMng Powders and Liquids. — Give 
an emetic if vomiting is absent, and follow it 
with copious draughts of water. 

• of Barium. — The same symptoms as 
mineral acids, with the addition of violent cramps 
and convulsions, headache, excessive weakness, 
dimness of sight and double vision. 

Treatment. — An emetic, followed by dilute 
solution of sulphate of magnesia or soda. 

Sulphide of Potassium produces the same symp- 
toms as mineral acids, with the addition of con- 



516 Dr. J. KearVs Lectures. 

vulsions or stupor, and the odor of sulphuretted 
hydrogen gas. 

Treatment. — Dilute solutions of chloride of 
soda or lime. 

METALS. 
ARSENIC AND ITS SALTS. 

Symptoms begin within an hour or so of its 
being taken, and consist of burning pain at the 
stomach, increased by pressure, with sickness 
and vomiting, renewed by the act of swallowing, 
constriction of the throat, intense thirst, inflam- 
mation and smarting of the eyes, headache, 
violent beating of the heart, quick pulse and 
frequent catching breathing, great weakness, rest- 
lessness, convulsive twitchings in the limbs, and 
cramps, but usually the mind is unaffected. The 
symptoms of arsenic poisoning, however, are 
liable to great variations. 

Treatment. — An emetic, followed at once by 
hydrated oxide of iron, which may be produced 
by pouring ammonia into a bottle of tincture of 
iron. 

ANTIMONY AND ITS SALTS. 

Tartar emetic is the most common preparation. 
Symptoms are a strong metallic taste in swal- 
lowing, with heat, constriction, and soreness of 
the mouth, followed by sickness, vomiting, pain 
and tenderness over the abdomen, succeeded by 



Caustic Lime. 517 

severe cramps, cold skin, clauimy perspiration, 
small quick pulse, great weakness, and at times 
convulsions. 

Treatment. — Tincture of cinchona, large 
quantities of strong tea, decoction of oak bark, 
or anything containing tannin. 

COPPER AND ITS SALTS. 

A quarter of an hour or more after swallowing 
the poison colicky pains, sickness, eructation, 
vomiting of bluish or greenish matters, purgings, 
cramps, sometimes convulsions, palsy and insen- 
sibility. 

Treatment. — White of egg in water, milk, 
wheat flour and water. 

SILVEE. 

Treatment. — Take common salt dissolved in 
water. 

TIN AND ZINC. 

Treatment. — White of egg^ milk, magnesia, 
wheat flour, chalk, soapsuds, dilute solution of 
carbonate of soda. 

CAUSTIC LIME. 

Take carbonic acid, the most convenient shape 
being a bottle of soda water, or dilute sulphuric 
acid. 



518 Dr. J. Kean y s Lectures. 

IODINE AND ITS PREPARATIONS. 

Treatment. — Boiled starch, potatoes, bread, 
flour and water, or any breadstuff after being 
scalded with boiling water. 

NARCOTICS. 
OPIUM AND ITS PREPARATIONS. 

More than half of the whole number of cases 
of poisoning are due to opiates. It is especially 
frequent with infants — that eleven hundred were 
"soothed" to death in the United States in the 
course of two years, is not a high estimate. 

The symptoms vary very greatly in different 
cases, but are chiefly giddiness, drowsiness and 
listlessness, followed by stupor, passing gradually 
into a state of complete insensibility. At first 
the patient can be easily roused by loud noises, 
sudden movements or slight blows, but it soon 
requires violent shaking, loud speaking into the 
ear, slapping the hands or feet with the hand to 
rouse him, and he is kept awake with extreme 
difficulty, and at length he falls into a state of 
complete stupor with the eyes shut, the pupils 
contracted to the size of a pin's point and insen- 
sible to light; the breathing slow, noisy and 
snoring, the skin cold and damp, and the hands 
and feet livid. The symptoms usually appear in 
about half an hour, but there are often very great 
variations, and many people from peculiarity of 
constitution resist enormous doses, while others 



Delirinnts. 519 

are strongly affected by small doses. The treat- 
ment is first to empty the stomach by a table- 
spoonful of mustard mixed with tepid water. 
Dash cold water over the head and face till he is 
somewhat roused from the stupor. On no account 
let him sleep for six hours at least, after 
taking the drug, but keep him walking up 
and down, shake him, and halloo in his ear. 
If not aroused, apply electricity. When he 
begins to recover give him a cup of strong coffee. 
In the excited stage which follows poisoning, let 
him be wrapped in a wet sheet wrung out and 
covered with dry blankets. 

DELIKIANTS. 

BELLADONNA, HYOSCYAMUS, STRAM- 
ONIUM, SOLAXUM. 

All cause delirium with illusions of the senses 
and extreme dilation of the pupil, which is 
bright, sparkling and prominent. 

The symptoms of belladonna-poisoning art? 
dryness of the lips, mouth and throat, difficulty or 
inability of swallowing, impairment or loss of 
voice, dilated pupil, eyes prominent and spark- 
ling, vision indistinct or lost, face flushed and 
swollen, thirst, numbness of the limbs, giddiness 
[see Fig. 56], staggering gait, great mental ex- 
citement ending in delirium, either gay with 
pleasant illusions, uncontrollable laughter, and 
incessant talking, or furious. The general state 




Fig. 56.— Effects of Deliriants. 



Inebrianls. 521 

of the patient may resemble somnambulism, in- 
toxication and hydrophobia. In fatal cases stu- 
por commences, ending in death. 

Treatment. — After prompt use of an emetic 
such as mustard and water, give animal charcoal 
diffused in water, and after a time a full dose ol 
castor oil. The treatment of all the other pois- 
ons of this class is by prompt administration of 
an emetic, mustard to be preferred. 

INEBRIANTS. 

(Alcohol, Ether, Chloroform, Chloral.) 

When taken in excess, these poisons produce 
the appearance known as dead drunkenness. 
After a time the patient becomes speechless, mo- 
tionless, and insensible, the pupil does not re- 
spond to light, and the breathing is slow and 
snoring. 

Treatment. — As for opium-poisoning, with the 
addition of artificial respiration (see Drowning, 
page 495), when required. 

Carbolic acid when taken, causes a burning 
sweetish sensation in the mouth and throat, rap- 
idly followed by a feeling of giddiness and intox- 
ication, which passes into a state of stupor, with 
great prostration, snoring breathing, and lower- 
ing of temperature, with contraction of the pupil. 

Treatment. — After an emetic, olive oil and 
lime water, or solution of permanganate of 
potash. 



522 Dr. J. Kearts Lectures. 

CONVULSIVES. 

(Strychnia and Nux Vomica.) 
In a few minutes after the poison, which is in- 
tensely bitter, is taken, the symptoms begin with 
a feeling of suffocation and want of air, followed 
by twitch ings of the muscles, cramps, and jerk- 
ing movements of the head and limbs, till at 
length all the muscles are firmly contracted, the 
body resting on the head and heels, the face be- 
comes livid and congested, the eyes prominent 
and staring, the pupil dilated, and the features 
drawn into a ghastly grin. After the paroxysm 
has continued one or two minutes, there is a short 
remission. The patient feels the approach of the 
next fit and cries out. If he survives for two 
hours, there is a fair chance of recovery. 

Treatment. — An emetic, followed by adminis- 
tration of chloroform. 

DEPRESSANTS. 

(Hemlock, Tobacco, Lobelia.) 
Hemlock causes gradual paralysis, beginning 
at the extremities, and finally convulsions. To- 
bacco and lobelia cause vomiting, giddiness, 
trembling, extreme depression, and convulsions. 
Treatment of all of them consists in an 
emetic of mustard, followed by a cup of strong 
hot coffee and a glass of brandy, succeeded by a 
dose of castor oil. 



Slings and Bites. 523 

ACONITE. 

The symptoms are numbness, tingling, and 
burning heat in the mouth, followed by sickness, 
vomiting, giddiness, blindness, singing in the 
ears, speechlessness, great muscular feebleness, 
difficult breathing, and a sense of sinking. 

Treatment same as the preceding. 

CANTHARIDES 
(Spanish Fly.) 

Soon after taking there is a burning sensation 
in the mouth and throat, followed by the same 
feeling at the stomach, accompanied with pain in 
swallowing, great thirst, copious discharge of 
blood in the urine, straining, pain in the loins, la- 
borious breathing, sometimes headache, delirium 
and convulsions. 

Treatment. — Free vomiting, a dose of castor 
oil along with twice as much olive oil. When 
there is bloody urine, a dose of laudanum. 

STINGS AND BITES. 

For the most common stings, those of bees and 
wasps, after extracting the sting and pressing a 
watch-key over the spot to press out the venom, 
rub over the spot some moist bicarbonate of soda. 

For stings of other venomous insects, tincture 
of iodine is a good application. 

For serpent bites, in many cases treatment is 



524 Dr. J. Kean^s Lectures. 

of no avail. A ligature should be tied round the 
limb near the heart, to prevent the poison flowing 
on in the blood, and the wound should at once 
be sucked. Serpent poison can be swallowed 
with impunity, provided there be no scratch or 
crack in the lip or mucous membrane. If the 
bitten person has the resolution to do it at once, 
cutting out the bitten part is the best treatment 
For some serpent bites, large doses of alco- 
hol are the best remedy, so much so, that a rattle- 
snake is wasting his time in biting a drunken 
man. 

To enlarge further upon the subject of pois- 
ons would extend this lecture beyond my orig- 
inal design, nevertheless I should, in this 
connection, give my readers some plain pre- 
cautions respecting the care that should be 
used in the purchase and administration of 
medicines, some of which, of course, are pois- 
onous, if given in undue quantities; others, 
weak and ineffectual, and many adulterated, so 
that in some drugs there seems to be little or no 
medicinal virtue whatever. 

When the remedies under a given prescription 
are desired, be particular to copy them accurately 
in order that they can be compounded in exact ac- 
cordance with the formula. 

While it is to be hoped that all persons who 
may consult these lectures, preparatory to self- 
treatment, will exercise constant caution in the 



Precautionary Mules. 525 

preparation and administration of medicines, I 
in the meantime deem it highly important 
and proper to offer the subjoined 

PRECAUTIONARY RUIZES. 

1st. After reading such portion of the lecture 
as describes the complaint with which the patient 
is affected, see particularly the prescription given 
therefor, and use as directed. 

2d. If relief should not then be obtained, the 
cause may be owing to the inadvertance of the 
person compounding the prescription, or to the 
fact that the remedies were not selected with due 
care and discretion ; still another and prevalent rea- 
son very difficult to guard against, may be as- 
signed for failure of speedy relief, and that is the 
impurity of drugs. 

3d. In all such cases consult the author by 
mail, or personally, describing carefully the pa- 
tient's actual condition, and, as nearly as can be 
ascertained, the result of remedies administered 
under the prescription. 

4th. Then in the event of a discovery of any 
imperfections or errors alluded to in Kule Two 
(2), proper remedies of requisite strength and 
quality will at once be prepared and substituted 
under the personal supervision of the author, and 
forwarded either by mail or express in a perfect 
state of preservation, fully protected from any 
loss of strength or diminution of quantity. 



LECTUKE XVIII. 

Mock Colleges and Quacks. — Science: What it has Done. 
— Its results in Continental Europe, England, and the 
United States Compared. — Imperfections of Human 
Affairs. — Wrecks of Trusted Leaders. — Growing Evils of 
Sham Colleges.— Inroads by Impostors upon the Medi- 
cal Profession. — Auctioned Diplomas. — Legislation 
Needed to Check. — Boards, Commissions, Committees 
Liable to be Swayed from Duty.— State Medical Faculty, 
and How it might be formed.— How Medical Profession 
is being Protected Against Invasion. 

MOCK COIililEGES A^D QUACKS. 

IF science has done much to elevate mankind 
it has also done much to debase it. The 
physician's prescription is to this day counter- 
signed with the device of a serpent and rod, 
which are the conquering symbols of the healing 
art ; yet the red typhon or dragon of Egypt, in 
the Aryan faith, is the type of the principle of 
evil which disputes with Osiris — representing the 
principle of good — for the dominion of the uni 
verse. Thus, if science brought with it good to 
elevate and give life to man, it has also brought 
with it evil, with which to degrade him and 
destroy his God-given life. 

Nor are free countries delivered from the evils 
which travel in the train of science while she is 



Mock Colleges and Quarks. 527 

dispensing her many goods ; in fact, the goddess 
is more lavish of these evils to the free people of 
England and the United States than to those of 
continental Europe, where paternal governments 
flourish. But, to be brief, the imperfections of 
human affairs have never yet been fully reformed, 
even in the limited sphere of the manufacture 
and sale of drugs. 

And since the hopeless ruin of unpitied victims 
within the last decade dates from the multitude of 
frauds, embezzlements, false oaths and bribery of 
banks, insurance companies, and other corpora- 
tions, some of whose highest officials have ab- 
sconded beyond seas with alarming amounts of 
money, what reformatory system could be 
devised to secure probity, fair dealing and good 
faith between man and man, in the comparatively 
private enterprise of manufacturing and vending 
drugs? Granting, for purposes of illustration, 
that drugs and medicines are to be found in their 
purity in the hands of dealers, still a greater and 
growing evil afflicts society, and one which 
every faithful citizen should most deprecate, and 
that is the vast inroads persistently made upon 
the medical profession by irresponsible and inex- 
perienced pretenders, who claim to be graduated 
physicians, yet never attended a day upon any 
college, except, perhaps, a few hours among the 
mock colleges to catch the cheapest diploma that 
might be auctioned off there, and thus fledged, 



528 Dr. J. KearVs Lectures. 

proceed to compound, adulterate, prescribe, and 
administer medicines, with the design of trump- 
ing up a stupendous bill against every patient so 
unfortunate as to rely upon him, only to be worse 
afflicted. 

But now let us proceed by calling for appro- 
priate legislation to correct the various abuses of 
drug adulterations, the sale of poisonous drugs by 
incompetent dealers, the practice of medicine by 
unqualified quacks, and the more dangerous 
abuse of mock colleges; in any of these cases 
prohibitory measures, too oppressive in their na- 
ture, might increase the very evils sought to be 
suppressed ; and especially might this be the re- 
sult in the familiar instances of earnest, industri- 
ous progressive men, whose predilections have 
led them to engage in the simpler branches of 
medical practice, with the cherished hope of some 
day deserving and receiving a diploma. 

It may be an easy task to formulate and enact 
laws, which, if faithfully executed, would speed- 
ily vindicate and preserve inviolate, the just 
rights of the medical profession, in that all self- 
constituted physicians should be subjected to a 
fixed test, under penalty, before being permitted, 
to further practice. 

Yet, considering the terrible corruption and 
treachery of some men in high places in the past, 
what guaranty could the people have that the 
laws referred to would be enforced ? 



Mock College* and Quarks. 529 

Boards might be organized, commissions ap- 
pointed, or committees selected, etc., with ample 
powers to force before them all drug-dealers and 
physicians for examination. Still the result 
might possibly be influenced either favorably or 
otherwise to the applicant, however worthy, by 
the presence or absence of ring-favor, or cash, or 
both. 

It would appear to me, that as an effective pal- 
ladium against further encroachments upon the 
medical profession by unqualified pretenders, the 
people could easily elect a State medical fac- 
ulty of examination with supervisory powers 
respecting the qualifications of medical prac- 
titioners, etc., and each member be required to 
file an approved bond for the faithful performance 
of his duties, as prescribed in a law which 
should be enacted for that purpose. 

Such a law would not necessarily work any 
oppression or hardship upon aspirants to the 
profession, if the standard test of competency to 
practice medicine were made reasonable, and 
equally open to all applicants for examination. 
Whether prominent or obscure, rich or poor, 
their qualifications should be recognized and 
respected alike, according to the merit of each 
one examined. 

The time has not been when the medical pro- 
fession was free from the curse of unprincipled 
pretenders and impostors ; and how to effectually 

34 



530 Dr. J. Kearts Lectures. 

banish these is a question which has long en- 
gaged the attention of zealous workers in the 
interests of the highest possible standard of the 
medical fraternity. Knowing this, I can but 
hope that these fearless advocates for the rights 
of the most important profession to man, will 
continue to press forward, receiving able co- 
adjutors on the way, until the victory they have 
long since earned is achieved, and its results are 
firmly established for all time to come. 



INDEX. 



PAGE. 

Preface 5 

Contents 9 

Illustrations- List of. . 14 

Alcohol 23, 49, 502, 521 

Asiatic Cholera 103 

Ague, the Shakes 115 

Acute Rheumatism 133 

Acute Gout 131 

Atonic Gout 135 

Anaemia 155 

Anasarca 159 

Acute Hydrocephalus. ..173 
Abscess of the Brain . . .180 
Atrophy of the Brain . . 185 

Apoplexv 180 

AtfccTioiis of the Eye. . .25:2 

Astigmatism 27(1 

Affections of the Ear.. .282 

Angina Pectoris 292 

A th eroma 294 

Aneurism 29(1 

Ague Cake 303 

Asthma 333 

Acute Consumption. . . . 345 
Acute Pneumonic Phthi- 
sis 34(1 

Acute and Sub - Acute 

Gastritis 389 

Affections of the Liver. .419 

Abscess of the Liver 420 

Acute Yellow Atrophy. .420 

Ascites .429 

Acne 4430 

Alkaline Spring .499 

Bed Sores . 46 

Breakbone Fever 84 

Black Eve 281 

Bleeding from the Ear. .285 

Breast-Pang 292 

Bleeding from the Nose .308 

Bronchitis 326 

Bronchi ectasis 33^ 

Bleeding from Lungs.. .338 
Bleeding from the Bow- 
els.... 404 

Bi-ight's Disease of the 

Kidney 437 

Bullions' 461 

Boils 462 



PAGE. 

Bald Spots 466 

Bleeding 487 

Braises 488 

Burns and Scalds 489 

Bathing 25 

Black Vomit 91 

Beri-Beri 159 

Contagia 37 

Constitutions 34 

Cerebro-Spinal Fever... 68 

Cynanche Parotidiea SH 

Chronic Gout 1 34 

Chronic Lupus Cancel 1 . 142 

Coffee 19 

Cocoa 19 

Clothing 26 

Chicken Pox 59 

Camp or Ship Fever. . .72 

Cholera Morbus 102 

Cholera Malignant 103 

Catarrh, Epidemic 105 

Childbed Fever 110 

Continued Fever 113 

Chronic Osteo-Arthritis.136 

Cancer 137 

Cretinism 149 

Chlorosis 156 

Chronic Hydrocephalus. 177 
OhroMc Dropsv of the 

Brain ' 177 

Coup de Soleil 183 

Cramps 223 

Child Crowing 225 

Chorea 227 

Conjunctivitis 257 

Corneitis Keratitis 267 

Cataract 272 

Changes in Shape and 

Power of the Eye 273 

Color Blindness.* 277 

Catarrh 304 

Cold in the Head 304 

Croup 313 

Consumption 344 

Consumption Chronic. 347 
Chronic Inflammation. .382 
Chronic Ulcer of the 

Stomach 391 

C an c e r of the S t o m a c h . 394 



532 



Index. 



PAGE. 

Colic 408 

Constipation 409 

Costivenees 409 

Cirrhosis 420 

Cancer of the Liver 421 

Congestion of the Liver.421 
Consumption of the 

Bowels 431 

Colica Nephritica 436 

Cystites 445 

Corns 460 

Chilblains 463 

Cleanliness 472 

Clothing 475 

Chafing of the Skin 478 

Convulsions 478 

Choking 490 

Cuts 491 

Dengue 84 

Diabetes Insipidus 152 

Diseases of the Brain 

and its Membranes. . .169 
Diseases of the Nervous 

System 161 

Diseases of the Spinal 

Cord 192 

Diminution of the Brain.185 
Diseases of the Nerves. 197 

Disinfectants 36 

Disorders of the Intel- 
lect 243 

Diphtheria 98 

Drinks 19, 48 

Drinks, Various 22 

Dwellings 30 

Diabetes 149 

Dropsy of the Brain. . .173 

Dementia 248 

Dilated Air Tubes 332 | 

Dyspepsia 370 \ 

Diseases of the Eyelids . 278 I 
Deficient Nervous En- . 

ergy 381 i 

Dysentery 399 

Dysentery, C hronic 403 

Diarrhcea 406 

Diarrhoea, Children 480 

Diseases of the Abdo- 
men 426 

Dropsy of the Abdomen. 429 



PAGE. 

Dislocations and Frac- 
tures 491 

Drowning 494 

Erysipelas 85 

Epidemic Catarrh 105 

Epithelioma 140 

Epithelial Cancer 141 

Exercise 24 

Encephalitis 170 

Enlargement of Brain. .185 

Epilepsy 215 

Earache 282 

Endocarditis 291 

Exophthalmic Goitre. . .301 

Epistaxis 308 

Emphvsema 337 

Erythema. 450 

Eczema 457 

Ecthyma 459 

Food 18, 47 

Fevers, General Diseases 32 
Fevers, General Treat- 
ment. 43 

Fevers — Infectious. 
Cerebro-Spinal Fever. 68 
Cynanche Parotidaaa. . 88 

Cholera 102 

Cholera, Asiatic 103 

Dengue 84 

Diphtheria 98 

Erysipelas 85 

Influenza 105 

Pertussis 89 

Plague 98 

Pyaemia 107 

Puerperal Fever 110 

Puerperal Ephemera. .111 

Rubeola Vulgaris 61 

" Rubeola 71 

Recurrent Fever 101 

Septicaemia 109 

Scarlet Fever 63 

Typhus Fever 72 

Typhoid Fever 77 

Variola ,. 51 

Varicella 59 

Yellow Fever 91 

Fe vers— N on-Infectious. 

Continued Fever 113 

Hydrophobia 119 



Index. 



533 



PAGE. 

Intermittent Fever. . .115 

Remittent Fever 114 

Facial Paralysis 205 

Functional Diseases 209 

Palling- Fits ..-215 

Facial Neuralgia 239 

Foreign Bodies in the 

Eye. 269 

Foreign Bodies in the 

Ear 286 

Fatty Heart 291 

Faultv Innervation 381 

Patty Liver 421 

Freckles 4(12 

Favus 465 

Flatulence 480 

Green Sickness 156 

General Diseases 32 

German Measles 71 

General Observations . . 17 

Gastric Fever 77 

Glosso - Laryngeal Par- 
alysis 208 

Gonorrhoea! Ophthal- 
mia 203 

Granulation of the Lids .265 
General Paralysis of the 

Insane .' 248 

Goitre 300 

Goitre Exophthalmic . .301 
Galloping Consumption. 346 

Glossitis 364 

Gall Stones 425 

Gravel 433 

Griping 480 

Hydrophobia 119 

Hiccough 50 

Hard Cancer 138 

Harmless Germs 35 

Heat 36 

Hospital Fever 109 

Hemorrhagic Diathesis . 153 
Hypertrophy of theBrain 185 

Hemiplegia 199 

Hysteria. 229 

Hordeolum 280 

Hypertrophy 292 

Hay Asthma 321 

Haemoptysis 338 

Hiemateinesis 393 



PAGE. 

Hemorrhoids 415 

Hsematoria 442 

Haemorrhage from the 

Bladder 442 

Herpes 455 

Herpes Zoster 455 

Hemorrhage 487 

Infection 37 

Influenza 105 

Intermittent Fever 115 

Inflammation of Spine 

and Brain 68 

Inflammation of Brain 

and Membranes 170 

Inflammation of Brain- 
Membranes 171 

Inflammation of the 

Brain 178 

Inflammation of the 
Membranes of the 

Cord 192 

Inflammation of the Spi- 
nal Cord 193 

Infantile Paralysis 204 

Intercostal Neuralgia. .241 

Irritable Breast. 241 

Infantile Convulsions. .212 
Inflammation of the 

Cornea 267 

Iritis 270 

Inflammation of the 

Iris 270 

Inflammation of the 
Edge of the Eyelids.. 278 

Inverted Eyelashes 280 

Inflammation of the Ex- 
ternal Ear and Drum .283 
Inflammation of the In- 
ner Ear 284 

Inflammation of the 

Pericardium 290 

Inflammation of the 

Heart 291 

Inflammation of the 

Veins 297 

Inflamed Spleen . : 303 

Inflammation of the 

Lungs 339 

Inflammation of the 
Lining of the Lungs. .356 



534 



Index. 



PAGE. 

Inflammation of the 

Mouth 361 

Inflammation of the 

Tongue 364 

Inflammation of the 

Throat 368 

Inflammation of the 

Gullet 369 

Indigestion 370 

Inflammation of the 

Stomach 389 

Inflammation of the 

Bowels 396 

Inflammation of the 

Kidney 441 

Inflammation of the 

Bladder 445 

Incontinence of Urine. .445 

Ichthyosis 455 

Itch 466 

Jaundice 422 

Local Diseases 160 

Lupus Cancer 141 

Leprosy 143 

Locomotor Ataxy 200 

Local Paralysis 205 

Lock-Jaw 209 

Laryngismus Stridulus . 225 

Long-Sight 274 

Laryngitis 309 

Lichen 451 

Lepra 454 

Liver Spots 466 

Medullary Cancer 140 

Mastodvriia 241 

Meals. . 18 

Milk 20 

Medicines 27, 50 

Medicines, Soothing 29 

Measles 61 

Mumps 88 

Malarious Yellow Fever.114 

Meningitis 171 

Myelitis 193 

Megrims 239 

Mania 244 

Melancholia 247 

Myopia 273 

Milk Leg 298 

Meltena 404 



PAGE. 

Mock Colleges and 

Quacks 526 

Nursing 45 

Nervous System, Diseas- 
es of...*. 161 

Neuralgia 238 

Night Blindness 277 

Nephritis 441 

Nettle Rash 450 

Osteomalacia 148 

Ophthalmia 257 

Ophthalmia Catarrhal . .257 
Ophthalmia Strumous. .259 
Ophthalmia Purulent. . .262 
Ophthalmia Purulent, of 

Infants 264 

Ophthalmia Gonorrhe- 
al 26:] 

Ozsena 307 

Oesophagitis 369 

Obstruction of the Bow- 
els 404 

Old Age and Degenera- 
tion 483 

Precautions 38 

Pertussis 89 

Pyaemia 107 

Puerperal Fever 110 

Puerperal Ephemera 111 

Purgatives 27 

Pesfe 98 

Plague 98 

Putrid Sore Throat 98 

Purple Color 153 

Purpura 153 

Pressure on the Brain.. 186 

Paralvsis 197 

Palsy 197 

Paraplegia 198 

Paralytic Stroke 199 

Progressive Muscular 

Atrophy 202 

Paralysis Agitans 206 

Palsy of the Tongue, Lips 

and Palate 208 

Pleurodynia 241 

Purulent Ophthalmia.. .262 
Purulent Ophthalmia of 

Infants 264 

Presbyopia 274 



Index. 



535 



PAGE. 

Pericarditis 290 

Palpitation 293 

Pjilpy Encysted Tumor. 294 

Phlebitis 297 

Phlegmatia Dolens 298 

Pneumonia 339 

Phthisis 344 

Pleurisv 356 

PharvnLatis 368 

Piles 415 

Peritonitis 427 

Prurigo 453 

Psoriasis 454 

Pemphigus; 456 

Precautionary Rules . . . .525 
Poisons. 

Alcohol.... 502,521 

Arsenic 505, 516 

Antimony 506, 516 

Ammonia Gas 513 

Ammonia, Strong 515 

Alum 515 

Aconite 523 

Ague, Brassfounders 1 .507 
Bleaching Powders. . .515 
Bleaching Liquids . . .515 

Belladonna 519 

Chromates 507 

Copper 507, 517 

Carbonic Acid Gas. . . .511 

Coal Gas 512 

Carbonic Oxide 512 

Charcoal Fumes 512 

Chlorine Gas 513 

Citric Acid 514 

Carbonate of Potash.. 515 

Carbonate of Soda 515 

Chloroform 521 

Chloral 521 

Carbolic Acid 521 

Cantharides 523 

, Digitalis 504 

Delirium Tremens 502 

Ergot 504 

Ergotism 504 

Ether 521 

Foxglove. Common... 504 
HydrochloricAcidGas 513 
Hydrochloric Acid 513 



TAGE. 

Hvoscvamus 519 

Hemlock 522 

Iodine 508,518 

Lime. Caustic 517 

Le a d ( ■ oil c an d Pal s v . 508 

Lobelia ^.. .522 

Mercury 510 

Nitric Acid 513 

N nx Vomica 522 

Oxalic Acid 514 

Opium 518 

Prussic Acid 514 

Potash, Caustic 515 

Potashes 515 

Pearlashes .515 

strychnia 505 

Sulphuretted Hydro- 
gen Gas 512 

Sulphuric Acid Gas.. 513 

Sulphuric Acid 513 

Silver 517 

Soda, Caustic 515 

Salts of Barium 515 

Sulphide of Potassi- 
um 51 5 

Stramonium 519 

Solanum 519 

Strychnia 522 

Stings and Bites 523 

Tartaric Acid 514 

Tin 517 

Tobacco 522 

Zinc... 517 

Quinsy 365 

Rubeola Vulgaris 61 

Rheumatic Fever 123 

Remittent Fever 114 

Rubeola 71 

Relapsing Fever 101 

Rheumatism 126 

Retrocedent Gout 136 

Rickets 146 

Raving Madness 244 

Running from the Ear. .285 

Retention of Urine 444 

Red or White Gum 453 

Rupia 457 

Ringworms 464 

Red Gum 481 



536 



Index. 



FAGE. 

Soothing Medicines 29 

Sick Room 43 

Swollen Abdomen 50 

Sleeplessness 50 

Septicaemia 109 

Secondary Cancer 139 

Scirrhns Cancer 138 

Scrofula 143 

Scurvy 154 

Salaam Convulsions — 224 
Spasms of the Muscles 

of the Neck 224 

Spasms of the Limbs. . .224 
Spasms of the Bladder. .224 

Sun Pain 239 

Sciatica 240 

Sleep 26 

Small Pox 51 

Scarlet Fever 63 

St. Anthony's Fire 85 

Surgical Fever 107 

Struma 143 

Softening of the Brain . .179 

Sunstroke 183 

Spinal Meningitis 192 

Spinal Apoplexy 194 

Spinal Hemorrhage 194 

Spina Bifida 196 

Shaking Palsy 206 

Scrivener's Palsy 207 

Spasms 223 

St. Vitus' Dance 227 

Strumous Ophthalmia. .259 

Short Sightedness 273 

Strabismus 277 

Squinting 277 

Sty 280 

Suppuration 285 

Sore Throat 309 

Stomatitis 361 

Stone in the Kidney 436 

Suppression of Urine . . .443 
Stone in the Bladder. . .446 

Skin, Redness of 450 

Shingles 455 

Scabies 466 

Sleep 473 



PAGE. 

Sprains 493 

To Relieve Distressing 

Symptoms 50 

Typhoid Fever 77 

Tic Douloureux 239 

Tea 19 

Test 20 

Teeth 25 

Typhus Fever 72 

Tumors on the Brain . . . 185 

Tetanus 209 

Trachoma 265 

Tinea Tarsi 278 

Toothache 

Tonsillitis 365 

Tubercle of the Liver. .421 

Tabes-Mesenterica 431 

Tetter 455 

Teething 475 

Thrush 481 

Ulcers of the Cornea. . .268 

Uncertain Sight 276 

Ulcers and Dropsy of the 

Windpipe 312 

Urine 447 

Urticaria 450 

Varicella 59 

Variola 51 

Vaccination 56 

Varicose Veins 299 

Vomiting of Blood 393 

Vomiting 482 

Water Test 20 

Water Filter, How to 

Construct 22 

Whooping Cough 89 

Weed Fever Ill 

Wasting Palsy 202 

Writer's Cramp 207 

Weak Sight 276 

Wry Neck 300 

Worms 412 

Waxv Liver 421 

Warts 462 

W^ounds, Incised 491 

Yellow Fever 91 



